Research Fellow Society of Brain Mapping and Therapeutics (SBMT) Trivandrum, Kerala, India
Introduction: Cervical compressive myelopathy is usually seen in adults, but rarely can be found in children as well mostly due to congenital anomalies. The Atlanto-Axial (C1-C2) joint is a very mobile and flexible joint, which is achieved by an array of ligaments that confer its mobility. This mobility of the joint makes it very vulnerable to subluxation/dislocation. Such subluxations/rotations are reported in children, especially children with Down’s Syndrome, and associated with trauma. In the index case it was due to an atlanto-axial dislocation with rotary subluxation (AARS). Though it usually occurs after trauma, in our case there’s no history of any trauma. We describe a case of congenital C1-C2 dislocation with rotary subluxation in an 11-year old female child.
Methods: Case presentation of an eleven-year-old female child with quadriplegia that developed over a week, without having any history of a definitive trauma. Clinical examination demonstrated upper and lower limb power grading of 3, and exaggerated reflexes. Diagnostic imaging demonstrated high cervical compressive myelopathy due to C1-C2 dislocation with rotary subluxation, and upward displacement of the odontoid process of C2.
Results: We performed DCER (distraction, compression, extension, and reduction) with a posterior approach to fix AARS. Patient improved significantly post-operatively: spasticity decreased, and upper and lower limb power increased to grade 4. One week post-operatively, the patient was able to walk with support and further two weeks later, she could walk without support and with upper and lower limb power of grade 4.
Conclusion : Cervical compressive myelopathy due to C1-C2 rotary subluxation is rarely seen in children, and hard to define, thus, proper diagnostic criteria becomes crucial. In this case, the definitive diagnosis was made by clinical examination along with radiological imaging such as CT scan and MRI. Regarding treatment, DCER is effective for treating high cervical compressive myelopathy, and the patient has shown continuous clinical improvement.
