Pediatric emergency medicine trisk 2996 2996
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extend the neck to tolerance without discomfort; care should be taken not to force these
movements. On some occasions, CT or MRI may be indicated.
The distance between the anterior surface of the odontoid and the posterior surface
of the anterior arch of atlas when measured in a lateral film with neck in flexion is
usually 4 mm or less. In the presence of AA subluxation, this may be as wide as 10 to
12 mm ( Fig. 101.10 ). Other radiologic abnormalities characteristic of cervical spine
involvement in JIA include loss of curvature, osteoporosis, erosions and sclerosis of
joints, disc-space narrowing, and altered height-to-width ratio of the vertebral bodies.
Although most children with AA subluxation do not have evidence of spinal cord
compression, the physician must be wary of its occurrence with excessive movement,
as occurs during endotracheal intubation. Regular use of a light plastic cervical collar is
often all that is required to relieve pain and prevent excessive anterior flexion,
particularly during automobile rides. In the presence of spinal cord compression,
surgical stabilization may be required.
