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DOI: 10.1055/s-0043-1776279
Complete C4-C5 Dislocation Secondary to Shallow Water Diving in a Child: A Case-Based Update
Luxação completa de C4-C5 secundária a mergulho em águas rasas em uma criança: atualização baseada em caso
Abstract
Introduction Pediatric spinal cord injury (PSCI) is rare, especially secondary to shallow water diving, with only a few cases recorded in the literature. Due to the low standardization in the diagnosis and treatment of this condition, each of these cases requires a personalized approach.
Case Description A 10-year-old female patient presented with tetraparesis and C5 sensory level secondary to spinal trauma due to shallow water diving. Computed tomography (CT) revealed complete C4-C5 dislocation, which led to a neurosurgical approach preceded by an intraoperative manual maneuver to reduce the dislocation. Following complete surgical reduction of the dislocation, the patient presented immediate significant neurological improvement.
Conclusion Children need to be warned about diving, as SCI due to shallow water diving has a poor neurological outcome. Despite that, early diagnosis, stabilization, and surgical approach can lead to immediate significant neurological improvement. Considering the peculiarities of pediatric patients and the existence of varying care techniques in the literature, more studies comparing surgical and nonsurgical outcomes are fundamental.
Resumo
Introdução A lesão medular pediátrica é rara, especialmente secundária ao mergulho em águas rasas, com poucos casos registrados na literatura. Devido à falta de padronização no diagnóstico e manejo desses casos, cada um deles requer uma abordagem individualizada.
Descrição do Caso Paciente do sexo feminino, de 10 anos de idade, que evoluiu com tetraparesia e nível sensitivo C5 secundário a trauma raquimedular após mergulho em águas rasas. A tomografia computadorizada revelou luxação completa de C4-C5, o que levou a uma abordagem neurocirúrgica precedida por uma manobra manual intraoperatória para redução da luxação. Após a redução cirúrgica completa, a paciente apresentou imediata melhora neurológica significativa.
Conclusão Deve-se orientar as crianças quanto aos mergulhos, pois lesão medular secundária ao mergulho em águas rasas não apresenta bom desfecho neurológico. No entanto, o diagnóstico precoce, a estabilização e a abordagem cirúrgica podem resultar em imediata melhora neurológica significativa. Levando em conta as peculiaridades dos pacientes pediátricos e a existência de diferentes técnicas de cuidado na literatura, é fundamental que se conduzam mais estudos de comparação dos desfechos cirúrgicos e não cirúrgicos.
Keywords
pediatric spinal cord injury - shallow water diving - cervical dislocation - spinal trauma managementPalavras-chave
trauma raquimedular pediátrico - mergulho em águas rasas - luxação cervical - manejo de traumas raquimedularesDeclaration of Patient Consent
The authors state that written informed consent regarding the publication of any potentially identifiable data included in this article was read and signed by the patient.
Financial Support and Sponsorship
The authors declare that they have received no financial support or sponsorship to conduct the present study.
Publication History
Received: 05 November 2022
Accepted: 05 July 2023
Article published online:
31 October 2023
© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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