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Pediatric Craniovertebral Junction Trauma

  • Mark E. Oppenlander
  • Justin C. Clark
  • Volker K. H. Sonntag
  • Nicholas TheodoreEmail author
Chapter
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 40)

Abstract

The craniovertebral junction consists of the occiput, atlas, and axis, along with their strong ligamentous attachments. Because of its unique anatomical considerations, trauma to the craniovertebral junction requires specialized care. Children with potential injuries to the craniovertebral junction and cervical spinal cord demand specific considerations compared to adult patients. Prehospital immobilization techniques, diagnostic studies, and spinal injury patterns among young children can be different from those in adults. This review highlights the unique aspects in diagnosis and management of children with real or potential craniovertebral junction injuries.

Keywords

Craniovertebral junction trauma Pediatrics 

References

  1. 1.
    Arvin B, Fournier-Gosselin MP, Fehlings MG (2010) Os odontoideum: etiology and surgical management. Neurosurgery 66(3 Suppl):22–31PubMedCrossRefGoogle Scholar
  2. 2.
    Bilston LE, Brown J (2007) Pediatric spinal injury type and severity are age and mechanism dependent. Spine (Phila Pa 1976) 32(21):2339–2347CrossRefGoogle Scholar
  3. 3.
    Birney TJ, Hanley EN Jr (1989) Traumatic cervical spine injuries in childhood and adolescence. Spine (Phila Pa 1976) 14(12):1277–1282CrossRefGoogle Scholar
  4. 4.
    Blauth M, Schmidt U, Otte D, Krettek C (1996) Fractures of the odontoid process in small children: biomechanical analysis and report of three cases. Eur Spine J 5(1):63–70PubMedCrossRefGoogle Scholar
  5. 5.
    Bosch PP, Vogt MT, Ward WT (2002) Pediatric spinal cord injury without radiographic abnormality (SCIWORA): the absence of occult instability and lack of indication for bracing. Spine (Phila Pa 1976) 27(24):2788–2800CrossRefGoogle Scholar
  6. 6.
    Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M et al (1997) Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 277(20):1597–1604PubMedCrossRefGoogle Scholar
  7. 7.
    Brown RL, Brunn MA, Garcia VF (2001) Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 36(8):1107–1114PubMedCrossRefGoogle Scholar
  8. 8.
    Buhs C, Cullen M, Klein M, Farmer D (2000) The pediatric trauma C-spine: is the ‘odontoid’ view necessary? J Pediatr Surg 35(6):994–997PubMedCrossRefGoogle Scholar
  9. 9.
    Bullough PE, Boachie-Adjei O (1998) Atlas of spinal diseases. Lippincott Williams & Wilkins, New YorkGoogle Scholar
  10. 10.
    Burkus JK, Deponte RJ (1986) Chronic atlantoaxial rotatory fixation correction by cervical traction, manipulation, and bracing. J Pediatr Orthop 6(5):631–635PubMedCrossRefGoogle Scholar
  11. 11.
    Cattell HS, Filtzer DL (1965) Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Joint Surg Am 47(7):1295–1309PubMedGoogle Scholar
  12. 12.
    Choit RL, Jamieson DH, Reilly CW (2005) Os odontoideum: a significant radiographic finding. Pediatr Radiol 35(8):803–807PubMedCrossRefGoogle Scholar
  13. 13.
    Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN (2004) Spinal injuries in children. J Pediatr Surg 39(4):607–612PubMedCrossRefGoogle Scholar
  14. 14.
    Currarino G (2002) Segmentation defect in the midodontoid process and its possible relationship to the congenital type of os odontoideum. Pediatr Radiol 32(1):34–40PubMedCrossRefGoogle Scholar
  15. 15.
    Davis PC, Reisner A, Hudgins PA, Davis WE, O’Brien MS (1993) Spinal injuries in children: role of MR. AJNR Am J Neuroradiol 14(3):607–617PubMedGoogle Scholar
  16. 16.
    Dickman CA, Greene KA, Sonntag VK (1996) Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery 38(1):44–50PubMedCrossRefGoogle Scholar
  17. 17.
    Dickman CA, Mamourian A, Sonntag VK, Drayer BP (1991) Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. J Neurosurg 75(2):221–227PubMedCrossRefGoogle Scholar
  18. 18.
    Dickman CA, Papadopoulos SM, Sonntag VK, Spetzler RF, Rekate HL, Drabier J (1993) Traumatic occipitoatlantal dislocations. J Spinal Disord 6(4):300–313PubMedCrossRefGoogle Scholar
  19. 19.
    Dickman CA, Rekate HL, Sonntag VK, Zabramski JM (1989) Pediatric spinal trauma: vertebral column and spinal cord injuries in children. Pediatr Neurosci 15(5):237–255PubMedCrossRefGoogle Scholar
  20. 20.
    Dickman CA, Zabramski JM, Hadley MN, Rekate HL, Sonntag VK (1991) Pediatric spinal cord injury without radiographic abnormalities: report of 26 cases and review of the literature. J Spinal Disord 4(3):296–305PubMedCrossRefGoogle Scholar
  21. 21.
    Dvorak J, Schneider E, Saldinger P, Rahn B (1988) Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res 6(3):452–461PubMedCrossRefGoogle Scholar
  22. 22.
    El-Khoury GY, Clark CR, Gravett AW (1984) Acute traumatic rotatory atlanto-axial dislocation in children. A report of three cases. J Bone Joint Surg Am 66(5):774–777PubMedGoogle Scholar
  23. 23.
    Eleraky MA, Theodore N, Adams M, Rekate HL, Sonntag VK (2000) Pediatric cervical spine injuries: report of 102 cases and review of the literature. J Neurosurg 92(1 Suppl):12–17PubMedCrossRefGoogle Scholar
  24. 24.
    Englander O (1942) Nontraumatic occipito-atlanto-axial dislocation. A contribution to the radiology of the atlas. Br J Radiol 15:341–345CrossRefGoogle Scholar
  25. 25.
    Evans DL, Bethem D (1989) Cervical spine injuries in children. J Pediatr Orthop 9(5):563–568PubMedCrossRefGoogle Scholar
  26. 26.
    Fassett DR, Clark R, Brockmeyer DL, Schmidt MH (2006) Cervical spine deformity associated with resection of spinal cord tumors. Neurosurg Focus 20(2):E2PubMedGoogle Scholar
  27. 27.
    Fesmire FM, Luten RC (1989) The pediatric cervical spine: developmental anatomy and clinical aspects. J Emerg Med 7(2):133–142PubMedCrossRefGoogle Scholar
  28. 28.
    Fielding JW, Cochran GB, Lawsing JF III, Hohl M (1974) Tears of the transverse ligament of the atlas. A clinical and biomechanical study. J Bone Joint Surg Am 56(8):1683–1691PubMedGoogle Scholar
  29. 29.
    Fielding JW, Hensinger RN, Hawkins RJ (1980) Os odontoideum. J Bone Joint Surg Am 62(3):376–383PubMedGoogle Scholar
  30. 30.
    Gerlock AJ Jr, Mirfakhraee M, Benzel EC (1983) Computed tomography of traumatic atlantooccipital dislocation. Neurosurgery 13(3):316–319PubMedCrossRefGoogle Scholar
  31. 31.
    Gluf WM, Brockmeyer DL (2005) Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients. J Neurosurg Spine 2(2):164–169PubMedCrossRefGoogle Scholar
  32. 32.
    Grabb PA (1999) Spinal column trauma in children. In: Albright AL, Pollack IF, Adelson PD (eds) Principles and practice of pediatric neurosurgery. Thieme, New York, pp 935–953Google Scholar
  33. 33.
    Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK et al (2002) Guidelines for the management of acute cervical spine and spinal cord injuries. Clin Neurosurg 49:407–498PubMedGoogle Scholar
  34. 34.
    Hamilton MG, Myles ST (1992) Pediatric spinal injury: review of 174 hospital admissions. J Neurosurg 77(5):700–704PubMedCrossRefGoogle Scholar
  35. 35.
    Hanley PA (1990) Special problems of spinal stabilization in children. American Association of Neurological Surgeons, Park Ridge, ILGoogle Scholar
  36. 36.
    Harris JH Jr, Carson GC, Wagner LK (1994) Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 162(4):881–886PubMedCrossRefGoogle Scholar
  37. 37.
    Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA (1989) Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg Am 71(1):15–22PubMedGoogle Scholar
  38. 38.
    Horn EM, Feiz-Erfan I, Lekovic GP, Dickman CA, Sonntag VK, Theodore N (2007) Survivors of occipitoatlantal dislocation injuries: imaging and clinical correlates. J Neurosurg Spine 6(2):113–120PubMedCrossRefGoogle Scholar
  39. 39.
    Horn EM, Lekovic GP, Feiz-Erfan I, Sonntag VK, Theodore N (2004) Cervical magnetic resonance imaging abnormalities not predictive of cervical spine instability in traumatically injured patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1(1):39–42PubMedCrossRefGoogle Scholar
  40. 40.
    Hutchings L, Atijosan O, Burgess C, Willett K (2009) Developing a spinal clearance protocol for unconscious pediatric trauma patients. J Trauma 67(4):681–686PubMedCrossRefGoogle Scholar
  41. 41.
    Judd DB, Liem LK, Petermann G (2000) Pediatric atlas fracture: a case of fracture through a synchondrosis and review of the literature. Neurosurgery 46(4):991–994PubMedGoogle Scholar
  42. 42.
    Keiper MD, Zimmerman RA, Bilaniuk LT (1998) MRI in the assessment of the supportive soft tissues of the cervical spine in acute trauma in children. Neuroradiology 40(6):359–363PubMedCrossRefGoogle Scholar
  43. 43.
    Klimo P Jr, Kan P, Rao G, Apfelbaum R, Brockmeyer D (2008) Os odontoideum: presentation, diagnosis, and treatment in a series of 78 patients. J Neurosurg Spine 9(4):332–342PubMedCrossRefGoogle Scholar
  44. 44.
    Laham JL, Cotcamp DH, Gibbons PA, Kahana MD, Crone KR (1994) Isolated head injuries versus multiple trauma in pediatric patients: do the same indications for cervical spine evaluation apply? Pediatr Neurosurg 21(4):221–226PubMedCrossRefGoogle Scholar
  45. 45.
    Launay F, Leet AI, Sponseller PD (2005) Pediatric spinal cord injury without radiographic abnormality: a meta-analysis. Clin Orthop Relat Res 433:166–170PubMedCrossRefGoogle Scholar
  46. 46.
    Lui TN, Lee ST, Wong CW, Yeh YS, Tzaan WC, Chen TY et al (1996) C1-C2 fracture-dislocations in children and adolescents. J Trauma 40(3):408–411PubMedCrossRefGoogle Scholar
  47. 47.
    Lustrin ES, Karakas SP, Ortiz AO, Cinnamon J, Castillo M, Vaheesan K et al (2003) Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics 23(3):539–560PubMedCrossRefGoogle Scholar
  48. 48.
    MacKinnon JA, Perlman M, Kirpalani H, Rehan V, Sauve R, Kovacs L (1993) Spinal cord injury at birth: diagnostic and prognostic data in twenty-two patients. J Pediatr 122(3):431–437PubMedCrossRefGoogle Scholar
  49. 49.
    Mandabach M, Ruge JR, Hahn YS, McLone DG (1993) Pediatric axis fractures: early halo immobilization, management and outcome. Pediatr Neurosurg 19(5):225–232PubMedCrossRefGoogle Scholar
  50. 50.
    Marino RJ, Ditunno JF Jr, Donovan WH, Maynard F Jr (1999) Neurologic recovery after traumatic spinal cord injury: data from the Model Spinal Cord Injury Systems. Arch Phys Med Rehabil 80(11):1391–1396PubMedCrossRefGoogle Scholar
  51. 51.
    Marshall KW, Koch BL, Egelhoff JC (1998) Air bag-related deaths and serious injuries in children: injury patterns and imaging findings. AJNR Am J Neuroradiol 19(9):1599–1607PubMedGoogle Scholar
  52. 52.
    Menticoglou SM, Perlman M, Manning FA (1995) High cervical spinal cord injury in neonates delivered with forceps: report of 15 cases. Obstet Gynecol 86(4 Pt 1):589–594PubMedCrossRefGoogle Scholar
  53. 53.
    Montane I, Eismont FJ, Green BA (1991) Traumatic occipitoatlantal dislocation. Spine (Phila Pa 1976) 16(2):112–116Google Scholar
  54. 54.
    Nypaver M, Treloar D (1994) Neutral cervical spine positioning in children. Ann Emerg Med 23(2):208–211PubMedCrossRefGoogle Scholar
  55. 55.
    Odent T, Langlais J, Glorion C, Kassis B, Bataille J, Pouliquen JC (1999) Fractures of the odontoid process: a report of 15 cases in children younger than 6 years. J Pediatr Orthop 19(1):51–54PubMedGoogle Scholar
  56. 56.
    Ogden JA (1984) Radiology of postnatal skeletal development. XII. The second cervical vertebra. Skeletal Radiol 12(3):169–177PubMedCrossRefGoogle Scholar
  57. 57.
    Osenbach RK, Menezes AH (1989) Spinal cord injury without radiographic abnormality in children. Pediatr Neurosci 15(4):168–174PubMedCrossRefGoogle Scholar
  58. 58.
    Pang D (2004) Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery 55(6):1325–1342PubMedCrossRefGoogle Scholar
  59. 59.
    Pang D, Li V (2005) Atlantoaxial rotatory fixation: part 3-a prospective study of the clinical manifestation, diagnosis, management, and outcome of children with alantoaxial rotatory fixation. Neurosurgery 57(5):954–972PubMedCrossRefGoogle Scholar
  60. 60.
    Pang D, Nemzek WR, Zovickian J (2007) Atlanto-occipital dislocation – part 2: the clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery 61(5):995–1015PubMedCrossRefGoogle Scholar
  61. 61.
    Pang D, Nemzek WR, Zovickian J (2007) Atlanto-occipital dislocation: part 1 – normal occipital condyle-C1 interval in 89 children. Neurosurgery 61(3):514–521PubMedCrossRefGoogle Scholar
  62. 62.
    Pang D, Pollack IF (1989) Spinal cord injury without radiographic abnormality in children – the SCIWORA syndrome. J Trauma 29(5):654–664PubMedCrossRefGoogle Scholar
  63. 63.
    Pang D, Wilberger JE Jr (1982) Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57(1):114–129PubMedCrossRefGoogle Scholar
  64. 64.
    Papadopoulos SM, Dickman CA, Sonntag VK, Rekate HL, Spetzler RF (1991) Traumatic atlantooccipital dislocation with survival. Neurosurgery 28(4):574–579PubMedCrossRefGoogle Scholar
  65. 65.
    Patel JC, Tepas JJ III, Mollitt DL, Pieper P (2001) Pediatric cervical spine injuries: defining the disease. J Pediatr Surg 36(2):373–376PubMedCrossRefGoogle Scholar
  66. 66.
    Phillips WA, Hensinger RN (1989) The management of rotatory atlanto-axial subluxation in children. J Bone Joint Surg Am 71(5):664–668PubMedGoogle Scholar
  67. 67.
    Pollack IF, Pang D, Sclabassi R (1988) Recurrent spinal cord injury without radiographic abnormalities in children. J Neurosurg 69(2):177–182PubMedCrossRefGoogle Scholar
  68. 68.
    Powers B, Miller MD, Kramer RS, Martinez S, Gehweiler JA Jr (1979) Traumatic anterior atlanto-occipital dislocation. Neurosurgery 4(1):12–17PubMedCrossRefGoogle Scholar
  69. 69.
    Rekate HL, Theodore N, Sonntag VK, Dickman CA (1999) Pediatric spine and spinal cord trauma. State of the art for the third millennium. Childs Nerv Syst 15(11–12):743–750PubMedCrossRefGoogle Scholar
  70. 70.
    Rinaldi I, Mullins WJ Jr, Delaney WF, Fitzer PM, Tornberg DN (1979) Computerized tomographic demonstration of rotational atlanto-axial fixation. Case report. J Neurosurg 50(1):115–119PubMedCrossRefGoogle Scholar
  71. 71.
    Ruge JR, Sinson GP, McLone DG, Cerullo LJ (1988) Pediatric spinal injury: the very young. J Neurosurg 68(1):25–30PubMedCrossRefGoogle Scholar
  72. 72.
    Scapinelli R (1994) Three-dimensional computed tomography in infantile atlantoaxial rotatory fixation. J Bone Joint Surg Br 76(3):367–370PubMedGoogle Scholar
  73. 73.
    Schippers N, Konings P, Hassler W, Sommer B (1996) Typical and atypical fractures of the odontoid process in young children. Report of two cases and a review of the literature. Acta Neurochir (Wien) 138(5):524–530CrossRefGoogle Scholar
  74. 74.
    Schultz KD Jr, Petronio J, Haid RW, Rodts GE, Erwood SC, Alexander J et al (2000) Pediatric occipitocervical arthrodesis. A review of current options and early evaluation of rigid internal fixation techniques. Pediatr Neurosurg 33(4):169–181PubMedCrossRefGoogle Scholar
  75. 75.
    Sherburn EW, Day RA, Kaufman BA, Park TS (1996) Subdental synchondrosis fracture in children: the value of 3-dimensional computerized tomography. Pediatr Neurosurg 25(5):256–259PubMedCrossRefGoogle Scholar
  76. 76.
    Sherk HH (1978) Fractures of the atlas and odontoid process. Orthop Clin North Am 9(4):973–984PubMedGoogle Scholar
  77. 77.
    Sherk HH, Nicholson JT, Chung SM (1978) Fractures of the odontoid process in young children. J Bone Joint Surg Am 60(7):921–924PubMedGoogle Scholar
  78. 78.
    Shirasaki N, Okada K, Oka S, Hosono N, Yonenobu K, Ono K (1991) Os odontoideum with posterior atlantoaxial instability. Spine (Phila Pa 1976) 16(7):706–715CrossRefGoogle Scholar
  79. 79.
    Spence KF Jr, Decker S, Sell KW (1970) Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am 52(3):543–549PubMedGoogle Scholar
  80. 80.
    Spierings EL, Braakman R (1982) The management of os odontoideum. Analysis of 37 cases. J Bone Joint Surg Br 64(4):422–428PubMedGoogle Scholar
  81. 81.
    Subach BR, McLaughlin MR, Albright AL, Pollack IF (1998) Current management of pediatric atlantoaxial rotatory subluxation. Spine (Phila Pa 1976) 23(20):2174–2179CrossRefGoogle Scholar
  82. 82.
    Sun PP, Poffenbarger GJ, Durham S, Zimmerman RA (2000) Spectrum of occipitoatlantoaxial injury in young children. J Neurosurg 93(1 Suppl):28–39PubMedCrossRefGoogle Scholar
  83. 83.
    Suss RA, Zimmerman RD, Leeds NE (1983) Pseudospread of the atlas: false sign of Jefferson fracture in young children. AJR Am J Roentgenol 140(6):1079–1082PubMedCrossRefGoogle Scholar
  84. 84.
    Swischuk LE, John SD, Hendrick EP (2000) Is the open-mouth odontoid view necessary in children under 5 years? Pediatr Radiol 30(3):186–189PubMedCrossRefGoogle Scholar
  85. 85.
    Traynelis VC, Marano GD, Dunker RO, Kaufman HH (1986) Traumatic atlanto-occipital dislocation. Case report. J Neurosurg 65(6):863–870PubMedCrossRefGoogle Scholar
  86. 86.
    Treloar DJ, Nypaver M (1997) Angulation of the pediatric cervical spine with and without cervical collar. Pediatr Emerg Care 13(1):5–8PubMedCrossRefGoogle Scholar
  87. 87.
    Vale FL, Burns J, Jackson AB, Hadley MN (1997) Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 87(2):239–246PubMedCrossRefGoogle Scholar
  88. 88.
    Vargas TM, Rybicki FJ, Ledbetter SM, MacKenzie JD (2005) Atlantoaxial instability associated with an orthotopic os odontoideum: a multimodality imaging assessment. Emerg Radiol 11(4):223–225PubMedCrossRefGoogle Scholar
  89. 89.
    Verska JM, Anderson PA (1997) Os odontoideum. A case report of one identical twin. Spine (Phila Pa 1976) 22(6):706–709CrossRefGoogle Scholar
  90. 90.
    Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR (2001) A prospective multicenter study of cervical spine injury in children. Pediatrics 108(2):E20PubMedCrossRefGoogle Scholar
  91. 91.
    Vogel LC, Krajci KA, Anderson CJ (2002) Adults with pediatric-onset spinal cord injuries: part 3: impact of medical complications. J Spinal Cord Med 25(4):297–305PubMedGoogle Scholar
  92. 92.
    Vogel LC, Krajci KA, Anderson CJ (2002) Adults with pediatric-onset spinal cord injury: part 1: prevalence of medical complications. J Spinal Cord Med 25(2):106–116PubMedGoogle Scholar
  93. 93.
    Vogel LC, Krajci KA, Anderson CJ (2002) Adults with pediatric-onset spinal cord injury: part 2: musculoskeletal and neurological complications. J Spinal Cord Med 25(2):117–123PubMedGoogle Scholar
  94. 94.
    Wang JC, Nuccion SL, Feighan JE, Cohen B, Dorey FJ, Scoles PV (2001) Growth and development of the pediatric cervical spine documented radiographically. J Bone Joint Surg Am 83-A(8):1212–1218PubMedGoogle Scholar
  95. 95.
    Ware ML (2006) Clinical biomechanics of the pediatric craniovervical junction and the subaxial spine. In: Brockmeyer DL (ed) Advanced pediatric craniocervical surgery. Thieme, New York, pp 27–42Google Scholar
  96. 96.
    White AA, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn. Lippincott Williams and Wilkins, PhiladelphiaGoogle Scholar
  97. 97.
    Wholey MH, Bruwer AJ, Baker HL Jr (1958) The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 71(3):350–356PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Mark E. Oppenlander
    • 1
  • Justin C. Clark
    • 1
  • Volker K. H. Sonntag
    • 1
  • Nicholas Theodore
    • 1
    Email author
  1. 1.Division of Neurological SurgeryBarrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenixUSA

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