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http://upload.orthobullets.com/topic/2048/images/lateral xray pseudosubluxation.jpg
http://upload.orthobullets.com/topic/2048/images/hangman fracture.jpg
Introduction
  • A physiologic (normal) pseudosubluxation of cervical vertebrae of up to 40% (or 4 mm) seen in young children.
  • Epidemiology
    • incidence
      • around 20% of children admitted for polytrauma will demonstrate this incidental finding
        • no associations with gender, trauma, intubation status or injury severity have been demonstrated
    • demographics
      • seen in children less than 8 years
    • location
      • C2 on C3 is most common 
      • C3 on C4 is second most common
  • Pathophysiology
    • caused by the horizontal nature of the facet joints at younger ages
      • facet joints become more vertical with age
Imaging
  • Radiographs
    • recommended views
      • lateral radiograph with flexion and extension
    • findings
      • reduction of subluxation with extension xrays
      • absence of anterior soft-tissue swelling (usually seen with traumatic cause)
    • measurements
      • Swischuk's line  
        • spinolaminar line drawn from spinolaminar point on C1 to C3
        • spinolaminar point on C2 should be within 1.5 mm of spinolaminar line
        • helpful to differentiate pseudosubluxation from true injury
Differential
  • True traumatic subluxation
    • factor that support pseudosubluxation as opposed to true traumatic subluxation include
      • reduction of subluxation with neck extension
      • spinolaminar line within 1.5mm of C2
      • no history or physical findings of significant trauma
      • absence of anterior soft-tissue swelling
    • true traumatic subluxation may be caused by
      • Hangman's fx  
Treatment
  • Nonoperative
    • observation
      • indications
        • psuedosubluxation
      • outcomes
        • no association with increased morbidity or mortality has been associated with this condition
 

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