Updated: 6/23/2021

Pseudosubluxation of the Cervical Spine

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  • summary
    • Pseudosubluxation of the Cervical Spine is a physiologic radiographic variant of the cervical spine of young children caused by the horizontal nature of the facet joints in younger ages.
    • Diagnosis is made radiographically with a relative anterior translation of C2 on C3 of up to 4 mm, that resolves with cervical spine extension.
    • Treatment is observation as the condition resolves with time as the cervical facet joints become more vertical with age.
  • 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
    • Anatomic location
      • C2 on C3 is most common
      • C3 on C4 is second most common
  • Etiology
    • 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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(OBQ08.169) A lateral radiograph of a 5 year-old child with no history of trauma is shown. The deformity reduces on extension radiographs. What is the most likely diagnosis.

QID: 555
FIGURES:
1

Traumatic spondylolisthesis of axis

1%

(34/3986)

2

Pseudosubluxation of the cervical spine

92%

(3684/3986)

3

Atlantoaxial instability (AP)

3%

(118/3986)

4

Rotatory atlantoaxial instability

1%

(37/3986)

5

Klippel-Feil Syndrome

2%

(85/3986)

L 1 D

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