Cervical spine trauma in children: a review

Todd McCall M.D., Dan Fassett M.D., and Douglas Brockmeyer M.D.
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  • Department of Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah
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✓ Injuries of the cervical spine are relatively rare in children but are a distinct clinical entity compared with those found in adults. The unique biomechanics of the pediatric cervical spine lead to a different distribution of injuries and distinct radiographic features. Children younger than 9 years of age usually have upper cervical injuries, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. Pediatric cervical injuries are more frequently ligamentous in nature, and children are also more prone to spinal cord injury without radiographic abnormality than adults are. Physial injuries are specific only to children. Radiographically benign findings, such as pseudosubluxation and synchondrosis, can be mistaken for traumatic injuries. External immobilization with a halo brace can be difficult and is associated with a high complication rate because of the thin calvaria in children. Surgical options have improved with the development of instrumentation specifically for children, but special considerations exist, such as the small size and growth potential of the pediatric spine.

Abbreviations used in this paper:

AP = anteroposterior; CT = computerized tomography; MR = magnetic resonance; NEXUS = National Emergency X-Radiography Utilization Study; SCI = spinal cord injury; SCIWORA = SCI without radiographic abnormality; VB = vertebral body.

✓ Injuries of the cervical spine are relatively rare in children but are a distinct clinical entity compared with those found in adults. The unique biomechanics of the pediatric cervical spine lead to a different distribution of injuries and distinct radiographic features. Children younger than 9 years of age usually have upper cervical injuries, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. Pediatric cervical injuries are more frequently ligamentous in nature, and children are also more prone to spinal cord injury without radiographic abnormality than adults are. Physial injuries are specific only to children. Radiographically benign findings, such as pseudosubluxation and synchondrosis, can be mistaken for traumatic injuries. External immobilization with a halo brace can be difficult and is associated with a high complication rate because of the thin calvaria in children. Surgical options have improved with the development of instrumentation specifically for children, but special considerations exist, such as the small size and growth potential of the pediatric spine.

Abbreviations used in this paper:

AP = anteroposterior; CT = computerized tomography; MR = magnetic resonance; NEXUS = National Emergency X-Radiography Utilization Study; SCI = spinal cord injury; SCIWORA = SCI without radiographic abnormality; VB = vertebral body.

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