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J Am Acad Orthop Surg, Vol 14, No 4, April 2006, 233-245.
© 2006 the American Academy of Orthopaedic Surgeons
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Nontraumatic Upper Cervical Spine Instability in Children

Brian P. D. Wills, MD and John P. Dormans, MD

Dr. Wills is Resident, Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI. Dr. Dormans is Chief of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, and Professor of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Wills and Dr. Dormans.

Reprint requests: Dr. Dormans, The Children’s Hospital of Philadelphia, Second Floor, Wood Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104.

The upper cervical spine begins at the base of the occiput, continues caudally to the C2-C3 disk space, and includes the occipitoatlantal and atlantoaxial joints. Nontraumatic upper cervical spine instability can result from abnormal development of osseous or ligamentous structures or from gradually increasing ligamentous laxity associated with connective tissue disorders. Such instability can lead to compression of the spinal cord during movement of the cervical spine. Establishing a correct diagnosis includes performing a thorough physical examination as well as evaluating radiographic relationships and measurements. Appropriate management of syndromes associated with instability of the upper cervical spine includes preventive care and recommendations for sports participation. Surgical treatment for the upper cervical spine includes a posterior surgical approach, used for instability, and the use of rigid plate implants, wiring, and bone graft materials to achieve a solid spinal fusion.






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Copyright © 2006 by the American Academy of Orthopaedic Surgeons.