Marcelo Pinho Teixeira Alves1* and Teresa Leonor Vasconcelos Figueiredo2
1Department of Orthopedic Surgery, Hospital Dr. José Maria Grande, Portugal
2Department of Radiology, Algarve Medical School Faculty of Medicine, University of Algarve, Portugal
Cervical spine injury is rare in children. It is mostly seen in people who suffer from severe and significant trauma, occurring in 1% to 2% of these cases. Interpretation of cervical spine radiographs and clinical examination in children can be difficult. In children, the cervical spine presents variations from normality that must be known so that they are not interpreted as pathological, especially in a traumatic context, avoiding exposure to more radiation. The objective of this paper is to report a physiological radiological finding of the cervical spine in childhood that tends to be misjudged as pathological: The pseudo-subluxation of C2-C3. We report the case of a 30-month-old child who was brought to the emergency room due to traumatic brain injury and cervical trauma, caused by hitting a big object. She reported severe neck pain and headache, the mother denied syncope, nausea or vomiting. She mentioned pain on palpation of the vertebral apophyses of the cervical spine and paravertebral pain, without neurological compromise. On plain radiography, in lateral view, she presented a C2-C3 subluxation, without signs of fracture. She was immobilized with a cervical collar and a computed tomography scan was requested, which showed C2-C3 subluxation, with proper alignment of the posterior wall and rectification of the physiological curvature. She was reassessed early in the consultation; she was asymptomatic, the control radiograph showed normalization of the cervical rectification and confirmed the absence of a lesion. It is important to know the Swischuk line in the radiographic study, which may be sufficient for the initial assessment. However, given the possibility of an acute injury to the cervical spine, CT should be considered. A multidisciplinary consensus should be established.
Alves MPT, Figueiredo TLV. C2-C3 Pseudo-Subluxation – Importance in Urgent Assessment of Cervical Spine Trauma in Childhood. Clin Surg. 2021; 6: 3353..