Overview

Pediatric cervical spine surgery is a treatment option for children who have injuries or abnormalities in the neck portion of the spine (cervical spine).

Cervical spine disorders may be present at birth (congenital) or result from a car or motorcycle accident or other injury. Cervical spine abnormalities are rare, occurring most often in children who have Down syndrome, Klippel-Feil syndrome or bone disorders.

Cervical spine injuries or abnormalities can cause bony structures to press the skull against the brainstem or upper part of the spinal cord. This compression may cause spinal cord problems or abnormal brain development. Surgery relieving this compression can help prevent deformity, chronic pain and loss of nerve function.

Why it's done

If your child has a cervical spine injury or abnormality, bony structures may press the skull against the brainstem or upper part of the spinal cord.

Your child's surgeon will remove those bony structures or abnormalities to help prevent loss of nerve function, chronic pain and deformity. If there's a deformity, your surgeon will straighten the crooked cervical spine. Sometimes pediatric cervical spine surgery is done to correct instability between the bones, which may injure the spinal cord. Metal implants including rods and screws may be used to treat the cervical spine disorder.

Risks

Pediatric cervical spine surgery can be challenging because children's bones are small, and surgeons must account for the child's future growth and development.

Possible risks of pediatric cervical spine surgery include:

• Neck pain
• Bleeding
• Spinal cord injury
• Infection
• Deformity
• Stiffness

How you prepare

Let your doctor know if your child is taking any medications or dietary supplements.

Schedule any preoperative tests requested by your child's doctor.

Have your child stop eating and drinking at midnight the night before surgery (unless your doctor has instructed otherwise).

What you can expect

Before the procedure

Your child will be put under general anesthesia before and during any pediatric spine procedure. Parents can sometimes be present for the initiation of anesthesia with the OK of the anesthesiologist.

If prior to surgery your child has instability that could be harmful, he or she will be placed in a device that keeps the spine stable, such as a cervical collar or halo ring. Cervical collars and other braces generally don't require anesthesia or an operating room for placement, but halo rings do.

During the procedure

The most appropriate surgical approach depends on the location of the bone injury or abnormality. The surgeon may recommend approaching the spinal cord or brainstem:

• Through the mouth (transoral approach). A flexible tube with a camera at the tip (endoscope) may be used.
• Through an incision in the neck, either in the front or back.
• Through an incision in the back.

During the procedure, the surgeon will remove bony structures or small pieces of bone that are pressing on your child's brainstem or spinal cord.

If your child's spine is unstable, the surgeon may insert plates, screws or bone grafts to help stabilize it. Bone grafts may come from another part of your child's body or from donated bone.

After the procedure

After surgery, your child will generally stay in the recovery area until he or she wakens from the anesthesia. In most cases, you'll be able to see your child in the recovery room.

The length of your child's hospital stay will depend on the type of surgical procedure, but generally lasts between three and five days after pediatric cervical spine surgery.

Most children can return to school within a week or two, and begin participating in physical education at about six weeks. Children can return to all of their activities as soon as a fusion can be seen on postoperative imaging tests.

Children don't usually need physical or occupational therapy after surgery.