# Gallie technique in the treatment of odontoid fracture in pediatric: A case report

## TL;DR

A 11-year-old girl with an odontoid fracture was successfully treated using the Modified Gallie procedure, highlighting its effectiveness in pediatric cervical spine injuries.

## Contribution

The paper presents a novel application of the Modified Gallie procedure in a pediatric case with an odontoid fracture and spinal cord compression.

## Key findings

- The Modified Gallie procedure provided stable post-operative outcomes in a pediatric patient with odontoid fracture.
- The patient showed improved motor and sensory function three months post-surgery.
- The procedure reduced the need for additional bone grafts by using the resected C2 bone as an onlay graft.

## Abstract

Pediatric cervical spine injuries (CSI) account for 60–80 % of all pediatric spine injuries and remains a challenge due to the difference in spinal anatomy compared to adults. There are currently no standardized method of diagnosis and treatment for CSI in children, hence identification and management remain challenging for orthopaedic surgeons.

a 11-year-old girl present with weakness on right upper and lower limb due to hyperflexion injury after her father accidentally fell on her neck. Initial radiology workup showed normal bony alignments and led to the misdiagnosis of Guillain-Barre Syndrome. However, further CT and MRI workup revealed odontoid fracture compromising the spinal canal, which caused anterior cord syndrome. She was managed by Modified Gallie procedure, which involves passing a sublaminar wire in C1-C2 and using the resected part of C2 from the subsequent decompression as an onlay type graft. Her condition was stable post-operatively and 3-months follow up showed improved motor and sensory function in ASIA Score. Patient had even returned to school and regained mobilization using a walker.

Upper cervical injuries in younger patients are common due to their anatomy and flexibility allowing immediate self-reduction post dislocation, which may cause the initial normal radiography. Modified Gallie procedure and decompression was selected as the treatment to alleviate the need of additional bone graft.

Cervical spine injury in children is a rare but challenging entity, where successful management requires an understanding of pediatric anatomical differences and the specific patterns of pathologies that frequently occur.

•There are currently no standardized method of diagnosis and treatment for CSI in children, hence identification and management remain challenging for orthopaedic surgeons•Management of odontoid fracture of our patient include stabilization of the vertebral segments using Modified Gallie procedure, followed by decompression by hemilaminectomy and hemilaminotomy to address the spinal cord edema

There are currently no standardized method of diagnosis and treatment for CSI in children, hence identification and management remain challenging for orthopaedic surgeons

Management of odontoid fracture of our patient include stabilization of the vertebral segments using Modified Gallie procedure, followed by decompression by hemilaminectomy and hemilaminotomy to address the spinal cord edema