Technical note: Traumatic atlanto-occipital dislocation and severe subaxial cervical distraction injury in an infant

This case report describes a complex spinal injury in a young child and the surgical techniques used to address it. A 13-month-old male suffered an atlanto-occipital dislocation and a severe C6-7 distraction injury after a motor vehicle accident. The patient underwent a posterior instrumented fusion, which involved stabilizing the spine using instrumentation placed from the back of the neck. This included fusion at the occiput-C2 and C6-7 levels. Postoperatively, the patient showed improvement, regaining functional use of his hands within a month. Follow-up imaging confirmed bony fusion and reduction of the C6-7 distraction, avoiding the need for an anterior fusion.

• 1
  Posterior instrumented fusion with laminar hooks and polyester tape can be a viable option for stabilizing severe cervical spine injuries in infants when traditional screw fixation is not feasible due to small bone size.
• 2
  Spontaneous reduction of subaxial distraction injuries can occur after posterior stabilization and halo placement, potentially obviating the need for anterior fusion in infants.
• 3
  Suboccipital autograft can be used effectively as fusion material in both occiput-C2 and subaxial cervical fusion sites in infants.