Spine Injury: Cervical, Pediatric

Spine Injury: Cervical, Pediatric is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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)

Etiology

  • Birth – breech vaginal delivery
  • <8 yr – MVC and falls
  • >8 yr – MVC and sports injuries

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Basics

Description

  • 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)

Etiology

  • Birth – breech vaginal delivery
  • <8 yr – MVC and falls
  • >8 yr – MVC and sports injuries

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