Spine Injury: Cervical, Pediatric

Basics

Relatively rare, present in 1–2% of patients with severe blunt trauma
Children <8 yr of age are more likely to have upper cervical spine injuries (C1–C3) and are at risk of growth plate injuries:
- Spinal fulcrum is higher (C2–C3 at birth)
- Relatively larger head to body
- Weaker cervical musculature
- Ligamentous laxity
- Immature vertebral joints
Children >8 yr of age:
- Increased incidence of pancervical injuries
- Vertebral body and arch fractures
- Lower cervical spine injuries more common
Special considerations:
- Down syndrome
- Klippel–Feil syndrome
- Morquio syndrome
- Larsen syndrome
Spinal cord injury without radiographic abnormality (SCIWORA):
- Based on study population, incidence from 4.5–35% of children with spinal injuries
- More common in children <8 yr of age
- May present as definite spinal cord injury:
  - Spinal shock
  - Neurologic deficits
- Symptoms may be transient and have resolved by time of evaluation:
  - Paresthesias
  - Burning sensation of hands
  - Weakness
- Symptoms often occur immediately after injury but may have delayed onset (i.e., minutes to days)

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