Acute Progressive Pediatric Post-Traumatic Kyphotic Deformity

Abstract

Cervical kyphosis is a rare entity with challenging management due to the limitations of pediatric age, along with a growing spine. The pathogenesis is made up of a large group of congenital, syndromic and acquired deformities after posterior element deterioration or as a result of previous trauma or surgery. In rare progressive cases, kyphotic deformities may result in severe "chin-on-chest" deformities with severe limitations. The pathogenesis of progression to severe kyphotic deformity after minor hyperflexion trauma is not clear without an obvious MR pathology; it is most likely multifactorial. The authors present the case of a six-month progression of a pediatric cervical kyphotic deformity caused by a cervical spine hyperflexion injury, and an MR evaluation without the pathology of disc or major ligaments. Surgical therapy with a posterior fixation and fusion, together with the preservation of the anterior growing zones of the cervical spine, are potentially beneficial strategies to achieve an excellent curve correction and an optimal long-term clinical outcome in this age group.

Keywords: cervical spine; chin-on-chest deformity; deformity; kyphosis; pediatric; trauma.

Figure 1

Radiographical evolution of progressive cervical kyphosis after a minor hyperflexion injury. (A) Physiological cervical lordosis immediately after a motor vehicle accident. (B) Loss of cervical lordosis and C2–3 pseudoluxation one week after trauma (hard collar fixation). (C) Cervical kyphosis progression 3 months after trauma. (D) Chin-on-chest relief position the deformity 6 months after the trauma, before corrective surgery.

Figure 2

An MR scan performed three weeks after the injury shows that a kyphotic deformity is starting to form, but there are no direct signs of major disco-ligamentous injury. (A) T2-weighted sequences. (B) STIR-weighted sequences.

Figure 3

CT scan shows the fusion one year after surgery. (A,B) Sagittal slices of the fused cervical spine from C2 to C5. (C) Axial slice of C2 with transpedicular screw insertion and a high vertebral artery position on the left side. (D) Axial slice of the C5 bilateral transpedicular fixation.

Figure 4

Evolution of the cervical curve after the corrective posterior surgery and fusion. (A) Radiography performed immediately after the surgery revealed a correction to a flat, straight curve. (B) Restoration of the physiological curve after 3 years.