Ligamentous Injuries

Diagnostic criteria for instability in the pediatric spine is not as clearly defined as in the adult patient; however, useful parameters based on clinical and radiographic findings are considered to determine whether ligamentous disruption has occurred.

An atlanto-dens interval of greater than 4 mm is the upper limit of normal for children younger than 8 years of age. In adults, if this interval is greater than 3 mm, instability is likely as a result of rupture of the transverse ligament and a C1-C2 fusion is indicated. Damage to the alar ligaments is likely if the interval is between 5 and 10 mm and an interval greater than 10 mm suggests total ligamentous disruption.

The angle between adjacent vertebrae in adults is usually less than 11°; in pediatric patients, an angle of less than 7° associated with neck pain mandates placement of a rigid collar for 5 days, after which time, in the case of a neu-rologically normal patient, flexion and extension films need to be undertaken to assess whether there is an accentuation of the angula-tion. If there is no change, the patient can be kept in a Philadelphia collar for 12 weeks; if there is an increase in the angulation, especially if the angulation is greater than 11°, treatment with halo placement or surgical fusion might be indicated. Pediatric patients who present with greater than 11° of angulation should undergo surgical fusion [37].

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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