Pediatric Cervical Spine Injuries

Pediatric Orthopedic Conditions Introduction Anatomical Considerations Classification & Types Clinical Assessment Imaging Studies Management Special Considerations

Pediatric Cervical Spine Injuries

Overview

Pediatric cervical spine injuries account for 60-80% of all spinal injuries in children. These injuries have unique characteristics due to the anatomical and biomechanical differences between children and adults.

Key Points

• More common in upper cervical spine (C1-C4)
• Higher incidence of SCIWORA (Spinal Cord Injury Without Radiographic Abnormality)
• Different injury patterns based on age groups
• Requires specialized management protocols
• Better recovery potential compared to adults

Associated Syndromes

• Down Syndrome (atlantoaxial instability)
• Klippel-Feil Syndrome
• Morquio Syndrome
• Osteogenesis Imperfecta
• Larsen Syndrome

Anatomical Considerations

Unique Pediatric Features

• Head Size and Weight:
  • Proportionally larger head
  • Higher fulcrum of motion
  • Increased biomechanical stress
• Ligamentous Laxity:
  • More elastic ligaments
  • Greater range of motion
  • Increased risk of subluxation
• Vertebral Body:
  • Wedge-shaped vertebrae
  • Horizontally oriented facet joints
  • Unfused synchondroses
• Growth Centers:
  • Multiple ossification centers
  • Potential for remodeling
  • Risk of growth disturbance

Age-Related Changes

• Infants (0-2 years):
  • Maximum flexibility
  • Predominantly cartilaginous spine
• Young Children (2-8 years):
  • Progressive ossification
  • Development of normal lordosis
• Older Children (8+ years):
  • More adult-like spine
  • Increased stability

Classification and Types

Upper Cervical Injuries (C1-C4)

• Atlanto-occipital Injuries:
  • Dislocation
  • Distraction
  • Often fatal
• Atlas (C1) Injuries:
  • Jefferson fractures
  • Anterior/posterior arch fractures
• Axis (C2) Injuries:
  • Odontoid fractures
  • Hangman's fractures
  • Synchondrosis fractures

Lower Cervical Injuries (C5-C7)

• Compression Injuries
• Burst Fractures
• Facet Dislocations
• Growth Plate Injuries

SCIWORA

• Characteristics:
  • Neurological deficit
  • Normal radiographs
  • More common in young children
• Mechanisms:
  • Flexion-extension
  • Distraction
  • Direct cord injury

Clinical Assessment

Initial Evaluation

• Primary Survey:
  • Airway protection
  • Breathing assessment
  • Circulation status
  • Neurological status
• History:
  • Mechanism of injury
  • Loss of consciousness
  • Associated injuries
  • Symptoms timeline

Physical Examination

• Inspection:
  • Neck alignment
  • Soft tissue swelling
  • Head position
• Palpation:
  • Tenderness
  • Step-offs
  • Muscle spasm
• Neurological Examination:
  • Motor function
  • Sensory testing
  • Reflexes
  • Rectal tone

Imaging Studies

Radiographs

• Standard Views:
  • Cross-table lateral
  • AP view
  • Open-mouth odontoid
• Dynamic Studies:
  • Flexion-extension views
  • Only when indicated
  • Under medical supervision

Advanced Imaging

• CT Scan:
  • Bone detail
  • Complex fractures
  • 3D reconstruction
• MRI:
  • Ligamentous injury
  • Cord signal changes
  • SCIWORA evaluation

Age-Specific Considerations

• Pseudosubluxation
• Normal variants
• Synchondrosis appearance
• Growth plate appearance

Management

Initial Stabilization

• Immobilization:
  • Age-appropriate collars
  • Log-roll precautions
  • Spinal board considerations
• Medical Management:
  • Pain control
  • Steroids (controversial)
  • Airway management

Definitive Treatment

• Conservative Management:
  • External immobilization
  • Collar types
  • Halo devices
  • Duration of treatment
• Surgical Intervention:
  • Indications:
    • Instability
    • Neurological deficit
    • Deformity
  • Techniques:
    • Anterior approach
    • Posterior approach
    • Combined approaches

Special Considerations

Rehabilitation

• Physical Therapy:
  • Range of motion exercises
  • Strengthening
  • Gait training
• Occupational Therapy:
  • Activities of daily living
  • Adaptive equipment
  • School reintegration

Long-term Follow-up

• Growth monitoring
• Deformity prevention
• Functional assessment
• Quality of life measures

Prevention Strategies

• Sports safety
• Car seat usage
• Playground safety
• Education programs

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.