EVALUATION OF CERVICAL SPINE INJURIES IN CHILDREN

Abstract

About 1% to 2% of all pediatric patients requiring hospital admission for traumatic injuries will have injuries to the cervical spine (C-spine). Although the incidence is relatively low, C-spine injuries in children can have devastating consequences with enormous emotional, social, and economic impact. They contribute to significant morbidity and mortality in children. A thorough understanding of C-spine injuries is essential so that these injuries are not overlooked.

The reported incidence of pediatric traumatic spinal injury (TSI) varies, and most of the previous published studies are limited because of the sparse attention to both the thoracic and lumbosacral region. Limitations of the definitive prevalence studies are due to that birth injuries and child abuse cases are underreported. Compared with adults, spinal trauma is relatively rare in pediatric patients. But the mortality rate is higher in children as a result of associated injuries. There are certain anatomic and biomechanical differences between the immature spine of pediatric patients and adults. These include a greater mobility of the spine owing to ligamentous laxity, shallow angulations of facet joints, immature development of neck musculature, and incomplete ossification of the vertebrae. As a result of these differences, 60 to 80% of all pediatric vertebral injuries are in the cervical region. This is in contrast to adults in whom cervical injuries constitute only 30 to 40% of all vertebral injuries. Consequently, our overall understanding of characteristics of pediatric TSI is incomplete. Proper patient evaluation is mandatory and this includes: