Cervical Spine Trauma in Children: A Review
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.
The treatment of cervical spine injuries in children must be founded on an understanding of spine development. Differences in injury patterns, interpretation of radiographic studies, and management of injuries are a direct result of the unique anthropometrics and biomechanics of a child. Historically, literature specifically addressing cervical spine injuries in children has been scarce; most studies have been focused on adults. In more recent years, as distinct aspects of the pediatric spine have been better appreciated, more attention has been given exclusively to injuries of the cervical spine in younger patients.
Besides incomplete knowledge regarding pediatric cervical injuries, other challenges exist in the management of these childhood traumas, such as the difficulty in obtaining a complete history from the patient and the unsuitability of some medical devices or surgical hardware for very young patients. Despite these obstacles, a logical and systematic diagnostic and treatment paradigm can be applied to the pediatric patient with a potential cervical injury. The purpose of this article is to highlight the differences between the adult and pediatric cervical spine, and to detail how these differences affect the diagnosis and treatment of traumatic injuries.
Abstract and Introduction
Abstract
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.
Introduction
The treatment of cervical spine injuries in children must be founded on an understanding of spine development. Differences in injury patterns, interpretation of radiographic studies, and management of injuries are a direct result of the unique anthropometrics and biomechanics of a child. Historically, literature specifically addressing cervical spine injuries in children has been scarce; most studies have been focused on adults. In more recent years, as distinct aspects of the pediatric spine have been better appreciated, more attention has been given exclusively to injuries of the cervical spine in younger patients.
Besides incomplete knowledge regarding pediatric cervical injuries, other challenges exist in the management of these childhood traumas, such as the difficulty in obtaining a complete history from the patient and the unsuitability of some medical devices or surgical hardware for very young patients. Despite these obstacles, a logical and systematic diagnostic and treatment paradigm can be applied to the pediatric patient with a potential cervical injury. The purpose of this article is to highlight the differences between the adult and pediatric cervical spine, and to detail how these differences affect the diagnosis and treatment of traumatic injuries.