Cervical spine injuries and instability in adolescent children due to trauma and other causes often lead to serious consequences, and surgical treatment is usually required for such patients. The most common surgical technique for cervical spine injuries is internal fixation with titanium implants, and nail rod systems and plate hooks are also commonly used. Indications for surgery in children with cervical spine trauma include cervical medullary compression, significant cervical spine deformity, dynamic cervical instability, and age over 8 years. Fixation and fusion techniques tend to have better results in the short term; however, long-term outcomes after cervical fusion in pediatric patients are associated with degeneration of adjacent segments, with the most common problems being degeneration of adjacent segments and decreased cervical mobility. There are no reports in the literature on the use of resorbable materials for spinal trauma fixation. Hamoud et al. reported a case of cervical spine trauma in a child using a new fixation technique with limited local exposure in the posterior approach and fixation with biodegradable medical sutures rather than an internal fixation fusion technique. The patient recovered well after surgery with satisfactory clinical and imaging performance. The results were published in the latest issue of the journal Injury. Case presentation A 23-month-old child was injured in a road traffic accident while walking on the road. Upon admission to the hospital emergency room, the examination revealed multiple injuries throughout the body, including chest contusions, diffuse axonal brain injury, and subarachnoid hemorrhage. A cervical spine X-ray showed severe flexion-distraction damage and C2-3 fracture dislocation (Figure 1), and CT reconstruction showed C2/C3 anterior dislocation with bilateral small joint displacement and right small joint locking (Figure 2). Sagittal MRI showed complete rupture of the C2-3 anterior and posterior longitudinal ligaments, complete separation of the C2 inferior endplate from the vertebral body, and partial separation of the posterior edge of the C3 superior endplate (Figure 3), but no significant damage to the C2/3 intervertebral disc. Figure 1. Cervical spine radiograph: C2-3 fracture dislocation. Figure 2. Sagittal reconstruction of the cervical spine CT: anterior dislocation of C2/C3 with bilateral small joint displacement and right small joint strangulation. Figure 3. Sagittal MRI: C2-3 anterior longitudinal and posterior longitudinal ligament rupture and separation of the C2 inferior endplate from the vertebral body. Surgical technique After successful general anesthesia, the patient was placed prone on a head frame to avoid pressure on the face and eyes. Because of the head injury, no Halo-vest frame was used for immobilization. Cervical spine X-ray confirmed that the cervical sequence was not aggravated during the patient’s positioning. A small incision was made in the posterior median of the upper cervical spine, and the skin and fascia were dissected to identify the C2 spinous process. The paravertebral muscles were peeled off with an electric knife and subperiosteal stripping to expose the C2 and C3 spinous processes to the spinous plate junction without exposing the plate and the rest of the spine. A small hole is made on each side of the bifurcation of the C2 spinous process and posterior to the junction of the spinous process and the lamina by means of a scarf clamp, and a No. 2 needle-bearing Vecchio suture (Johnson & Johnson Acuvue) is passed posteriorly and anteriorly through the above-mentioned hole (Fig. 4A) and around the underside of the C3 spinous process (Figs. 4B, 4C), and another suture is passed through the contralateral hole and below the C3 spinous process in the same manner. The sutures were then gradually tightened and knotted separately at the inferior margin of the C3 spinous process under imaging surveillance (Fig. 4E) to avoid overcorrection. No intraoperative bone graft was performed, a drainage tube was placed, the surgical incision was closed layer by layer, and a Philadelphia cervical brace was worn for 8 weeks postoperatively to protect the cervical spine. Figure 4. Detailed explanation of C2 and C3 fixation techniques. On the 3rd postoperative day, the patient was fully conscious, but there was still mild numbness in the left upper limb due to traumatic brain injury, and he recovered completely 4 weeks after surgery. MRI of the cervical spine at 15 months postoperatively showed a normal C2-3 sequence with good healing of the posterior longitudinal ligament and endplate, and a slightly widened C2-3 and C3-4 intervertebral space (Figure 5). At 63 months postoperatively, cervical hyperextension and hyperflexion X-ray showed no significant instability of C2-3, no cervical fusion, and good preservation of cervical mobility (Figure 6). Figure 5. MRI of the cervical spine at 15 months postoperatively. Figure 6. Cervical hyperextension and hyperflexion X-rays at 40 months (A) and 63 months (B) postoperatively. The authors concluded that the choice of surgical procedure is very important in children with cervical spine injuries. The technique has the following advantages: it avoids cervical fusion and its interference with growth; it preserves the mobility of the cervical spine; it does not require re-surgical removal because it does not require implantation of internal fixation; and it is a simple and cost-effective technique. Therefore, for some special cases, an absorbable and degradable fixation material can be chosen for stability reconstruction.