Preparation for Surgery for Cervical Spine Trauma in Children

Indications for Surgery

• Unstable fracture: Surgery is indicated for unstable fractures requiring immobilization in an external halo-vest orthosis or an internal fixation.
• Cord compression due to hematoma or bone fragments: Surgery is required for injuries resulting in spinal compression from hematoma or bone fragments.

Preoperative Orders

• Antibiotics: Prophylactic antibiotics are indicated prior to internal fixation procedures.

Anesthetic Considerations

Cervical spine trauma may have important anesthetic implications.

• Difficult intubation: Serious neck injury may be associated with oral swelling or prevertebral swelling compromising airway visualization. Additionally, neck movement should be minimized during intubation. These concerns can result in the need for fiberoptic or assisted intubation and the appropriate equipment.

Devices to Be Implanted

• Halo ring and jacket: The halo body jacket size should be measured prior to surgery. Consideration for the need of either the ring or jacket should be given before surgery. A ring alone will be required for halo traction. Halo traction is impractical in young children and so a full halo-body jacket can be applied with the option to distract further or realign according to radiological findings.
• Instrumentation for fixation: Appropriate cervical instrumentation should be requested with an adequate range of sizes of screws and plates. Sublaminar cables should be available. The small bone size of young children may preclude screw fixation. Sublaminar wires provide a useful alternative method of fixation.

Ancillary/Specialized Equipment

• X-ray: Fluoroscopy is required to ensure appropriate anatomical levels, to guide placement of instrumentation, and to confirm appearances before completion of surgery.
• Intraoperative CT: The use of the combination of neuronavigation with intraoperative CT is increasing in complex spinal surgery to optimize the accuracy and safety of screw placement.
• Intraoperative neurophysiological monitoring: If available, IOM (motor evoked potential and SSEPs) should be used.