{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T14:41:36Z","timestamp":1681569696660},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Cervical spondylolysis is a rare condition that results from a pars interarticularis defect. The C-6 level is the most frequently involved site in the cervical spine. Its clinical presentations range from incidental radiographic findings to neck pain and, rarely, neurological deficits. Although 150 patients with subaxial cervical spondylolysis have been reported, a mere 24 adult and pediatric patients with C-2 spondylolysis have been described. The long-term outcomes of very young children with bilateral C-2 spondylolysis are of great interest, yet only a few longitudinal studies exist.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors retrospectively reviewed 5 cases of bilateral C-2 spondylolysis at Texas Children's Hospital and Riley Children's Hospital; these were combined with 5 other cases in the literature, yielding a total of 10 patients. Data regarding the patients' age, sex, C2\u20133 angulation and displacement, associated spine anomalies, neurological deficits, treatment, and most recent follow-up were recorded.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The patients' ages ranged from 3 to 36 months (mean 12.9 months). There were 6 boys and 4 girls. The C2\u20133 angulation, displacement, and width of pars defect were measured when available. The mean C2\u20133 angulation was 9.5\u00b0 (range 1\u201334\u00b0), the mean C2\u20133 displacement was 4.78 mm (range 1.1\u201310.8 mm), and the mean width of the pars defect was 4.16 mm (range 0.9\u20137 mm). One patient developed myelopathy and spinal cord injury. All 10 of the patients were treated initially with conservative therapy: 3 with close observation alone, 1 with a rigid cervical collar, 4 with a Minerva jacket, 1 with a sternal-occipital-mandibular immobilizer, and 1 with a halo vest. Three patients ultimately underwent surgery for internal fixation due to progressive instability or development of neurological symptoms. All patients were neurologically intact at the last follow-up (mean 44.3 months, range 14\u2013120 months).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Based on the literature and the authors' own experience, they conclude that most very young children with C-2 spondylolysis remain neurologically intact and maintain stability in long-term follow-up despite the bony defect. This defect is often an asymptomatic incidental finding and may be managed conservatively. More aggressive therapy including surgery is indicated for those patients with a neurological deficit from spinal cord compromise secondary to stenosis and local C-2 kyphosis, progressive deformity, or worsening C2\u20133 instability.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.11.peds13422","type":"journal-article","created":{"date-parts":[[2013,12,20]],"date-time":"2013-12-20T15:03:41Z","timestamp":1387551821000},"page":"196-203","source":"Crossref","is-referenced-by-count":7,"title":["Spondylolysis of C-2 in children 3 years of age or younger: clinical presentation, radiographic findings, management, and outcomes with a minimum 12-month follow-up"],"prefix":"10.3171","volume":"13","author":[{"given":"Loyola V.","family":"Gressot","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhakar","family":"Vadivelu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven W.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Floating Children's Hospital, Boston, Massachusetts; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel H.","family":"Fulkerson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas G.","family":"Luerssen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Jea","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-peds13422","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E823","DOI":"10.1097\/01.brs.0000238656.65022.3d","article-title":"Rare bilateral C6 spondylolysis and spondylolisthesis in an adolescent athlete: evaluation with magnetic resonance imaging and multidetector computerized tomography","volume":"31","author":"Amin","year":"2006"},{"key":"b2-peds13422","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/BF00973536","article-title":"Congenital dysplasia of C2\u20136","volume":"6","author":"Archer","year":"1977"},{"key":"b3-peds13422","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1097\/01.brs.0000257345.21075.a7","article-title":"Measurement techniques for upper cervical spine injuries: consensus statement of the Spine Trauma Study Group","volume":"32","author":"Bono","year":"2007"},{"key":"b4-peds13422","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/BF02389566","article-title":"Primary spondylolysis of the axis vertebra (C2) in three children, including one with pyknodysostosis","volume":"19","author":"Currarino","year":"1989"},{"key":"b5-peds13422","series-title":"J Bone Joint Surg Br","first-page":"526","article-title":"Defects of the pedicle and spondylolisthesis of the second cervical vertebra","volume":"63B","author":"Fardon","year":"1981"},{"key":"b6-peds13422","series-title":"Rev Chir Orthop Reparatrice Appar Mot","first-page":"174","article-title":"[An unusual anomaly: cervical spondylolysis in an adult.]","volume":"85","author":"Fessy","year":"1999"},{"key":"b7-peds13422","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"751","DOI":"10.2214\/ajr.154.4.2107670","article-title":"Cervical spondylolysis: imaging findings in 12 patients","volume":"154","author":"Forsberg","year":"1990"},{"key":"b8-peds13422","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"682","DOI":"10.2214\/ajr.128.4.682","article-title":"Spondylolisthesis of the axis vertebra","volume":"128","author":"Gehweiler","year":"1977"},{"key":"b9-peds13422","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3171\/2010.3.SPINE09610","article-title":"Spondylolysis of C-2 in 2 athletically active individuals. 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Report of a case","volume":"75","author":"Smith","year":"1993"},{"key":"b32-peds13422","series-title":"Hong Kong Med J","first-page":"324","article-title":"Bilateral cervical spondylolysis in a young Chinese woman presenting with a neck injury","volume":"14","author":"Tam","year":"2008"},{"key":"b33-peds13422","series-title":"J Emerg Med","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.jemermed.2005.01.008","article-title":"An abused five-month-old girl: Hangman's fracture or congenital arch defect?","volume":"29","author":"van Rijn","year":"2005"},{"key":"b34-peds13422","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1007\/s002470050643","article-title":"CT appearance of congenital defect resembling the Hangman's fracture","volume":"29","author":"Williams","year":"1999"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/13\/2\/article-p196.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/13\/2\/article-p196.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/13\/2\/article-p196.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T14:10:39Z","timestamp":1681567839000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/13\/2\/article-p196.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,2]]},"references-count":34,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2013.11.peds13422","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2]]}}}