Cervical spine trauma in the injured child: A tragic injury with potential for salvageable functional outcome

doi:10.1053/jpsu.2000.18313

Journal of Pediatric Surgery

Volume 35, Issue 11, November 2000, Pages 1571-1575

Presented at the 33rd Annual Meeting of the Pacific Association of Pediatric Surgeons, Las Vegas, Nevada, May 15-19, 2000.

https://doi.org/10.1053/jpsu.2000.18313 Get rights and content

Abstract

Background/Purpose: Cervical spine injuries are uncommon in children, and, therefore, presumptive immobilization and diagnosis remain controversial. The purpose of this study was to review the author's experience with cervical spine injuries in children to determine the incidence, injury mechanism, pattern of injury, and subsequent functional outcome. Methods: Fifty-two children over a 6-year period (1994 to 1999) with a cervical spine injury secondary to blunt trauma were identified (1.3% incidence). The functional independent measure (FIM) was assessed at the time of discharge in each of 3 categories: communication, feeding, and locomotion. Results: Mean age of the study children was 10.7 ± 0.7 years. Eight children (15%) were less than 5 years old, and 4 (8%) were less than 2 years old. The mechanism of injury included motor vehicle crash (52%), falls (15%), bicycle accidents (11%), sports-related injuries (10%), pedestrian accidents (8%), and motorcycle crashes (4%). Seven patients died yielding an overall mortality rate of 13%. Injuries were distributed along the cervical spinal cord as follows: 5 atlanto-occipital dislocations, 28 C1 to C3 injuries, 17 C4 to C7 injuries, and 2 ligamentous injuries. FIM scores were recorded for 18 patients. Seventeen communicated independently, 14 fed themselves independently, and 12 had independent locomotive function. Conclusions: Cervical spine injuries occur in children across a spectrum of ages. Although atlanto-occipital dislocation is a highly lethal event, children with C1 to C7 injuries have a high likelihood of reasonable independent functioning. J Pediatr Surg 35:1571-1575. Copyright © 2000 by W.B. Saunders Company.

Section snippets

Patients

All patients less than 18 years of age admitted to the trauma service at The Children's Hospital (TCH) of Denver or Denver Health Medical Center (DHMC) with a radiographically documented cervical spine injury over a 6-year period (1994 through 1999) were identified by the trauma registry at each institution. Children with a penetrating mechanism of injury were excluded as were children with spinal cord injury without radiographic abnormality. The medical records were reviewed to confirm details

Results

The study population consisted of 52 children who had sustained cervical spine injury documented by physical examination and radiographic studies over the 6-year period ending December 1999. Twenty-nine of the patients were boys (56%), and they had a mean injury severity score of 22.5 ± 2.9. Mean age of the children sustaining cervical spine injuries was 10.7 ± 0.7 years with a wide range from 8 months old to 17 years old. Their age distribution is depicted in Fig 1.

. Age distribution of the

Discussion

There are substantial differences between children and adults in the clinical presentation as well as anatomy, diagnosis, and functional outcome for cervical spine injuries, especially for very young children.¹⁰ Previous investigators have documented that cervical spine injuries are uncommon in the pediatric trauma population.1, 2, 3 It is estimated that only 10% of spinal cord injuries occur in children.11, 12 Because these injuries are rare, the most appropriate and cost-effective means of

References (21)

KP Lally et al.
Utility of the cervical spine radiograph in pediatric trauma
Am J Surg
(1989)
AM Dietrich et al.
Pediatric cervical spine fractures: Predominantly subtle presentation
J Pediatr Surg
(1991)
C Baker et al.
Evaluation of pediatric cervical spine injuries
Am J Emerg Med
(1999)
KM Hall et al.
Characteristics of the functional independence measure in traumatic spinal cord injury
Arch Phys Med Rehab
(1999)
PC Ferrera et al.
Traumatic atlanto-occipital dislocation: A potentially survivable injury
Am J Emerg Med
(1996)
TG Givens et al.
Pediatric cervical spine injury: A three-year experience
J Trauma
(1996)
LS Etzwiler et al.
Cervical spine injuries
Pediatr Emerg Care
(1996)
MJ Manary et al.
Cervical spine injuries in children
Pediatr Ann
(1996)
JM Shamoun et al.
Atlanto-occipital subluxation/dislocation: A “survivable” injury in children
Am Surg
(1999)
JAB Currens
Evaluation of disability and handicap following injury
Injury
(2000)

There are more references available in the full text version of this article.

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Paediatric spinal trauma: patterns of injury, clinical assessment and principles of treatment
2016, Orthopaedics and Trauma
Citation Excerpt :
Vertebral column immobilization may be effective in the early stages of injury. In the presence of subsequent instability, surgical stabilization should be considered.24–29 Injuries to the bony structures are more frequent in older patients; these are easier to diagnose as they can be detected on plain X-rays.
Spinal fractures in children are almost always due to severe trauma as the result of road traffic accidents, significant falls, sporting activities or child abuse. This type of injury is most prevalent in the age groups of 5 years and younger or 10 years and older. Of all spinal fractures in children, 26–75% occur in the thoracic or lumbar region. 20% of children with a spinal fracture will have associated neurological compromise. Due to greater soft-tissue elasticity and the unique potential for bone remodelling during growth, injuries that occur in the paediatric spine present as different patterns compared to those in the adult population with certain injuries being unique to children. Such injuries exclusive to children are: a) spinal cord injury without radiographic abnormalities (SCIWORA), b) slipped vertebral apophysis, and c) spinal trauma in child abuse.
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Although this incidence is relatively low, CSI constitutes 60% to 80% of all pediatric spinal injuries [2]. Anatomical differences between pediatric and adult cervical spine are prominent until approximately 9 years of age [2,7,8]. Hence, previous reports have stratified pediatric patients with CSI into 2 groups: those 9 years or younger, which predominantly sustain upper CSI, and those older than 9 years, who commonly present with lower CSIs [2,3,5,6,9].
The objective of this study was to characterize the incidence, risk factors, and patterns of cervical spine injury (CSI) in different pediatric developmental ages.
A retrospective review of the National Trauma Data Bank was conducted for the period of January 2002 through December 2006 to identify pediatric patients admitted following blunt trauma. Patients were stratified into 4 developmental age groups: infants/toddlers (age 0-3 years), preschool/young children (age 4-9 years), preadolescents (age 10-13 years), and adolescents (age 14-17 years). Patients with a CSI were identified by the International Classification of Diseases, Ninth Revision codes. Demographics, clinical injury data, level of CSI, and outcomes were abstracted and analyzed.
A total of 240,647 patients met the inclusion criteria. Of these, 1.3% (n = 3,035) sustained a CSI. The incidence of CSI in the stratified age groups was 0.4% in infants/toddlers, 0.4% in preschool/young children, 0.8% in preadolescents, and 2.6% in adolescents. The level of CSI (upper [C1-C4] vs lower [C5-C7]) according to the age groups was as follows: infants and toddlers, 70% vs 25%; preschool/young children, 74% vs 17%; preadolescents, 52% vs 37%; and adolescents, 40% vs 45%, respectively. The adjusted risk for CSI increased 2-fold in preadolescents and 5-fold in adolescents.
The incidence of pediatric CSI increases in a stepwise fashion after 9 years of age. We noted an increase in lower CSI and a decrease in upper CSI after the age of 9 years. The incidence of upper CSI compared with lower CSI was higher in preadolescents (52% vs 37%) and almost equal in adolescents (40% vs 45%).
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2009, Injury Extra
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In younger children (0–9 years), the most common mechanisms of injury are falls and pedestrian accidents. These children are more likely to have injuries to the upper cervical spine, ligamentous injuries as opposed to fractures, severe and complete spinal cord injuries, and higher mortality rates.1,2,8,12,18,19 The pediatric cervical spine has several unique anatomic and biomechanical characteristics that have significant effect on the types of injuries children experience.7
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2009, Orthopaedics and Traumatology: Surgery and Research
Fracture of the odontoid process in children: A case report
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^☆: Address reprint requests to David A. Partrick, MD, The Children's Hospital, 1950 Ogden St, B-323, Denver, CO 80218.

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Cervical spine trauma in the injured child: A tragic injury with potential for salvageable functional outcome☆

Abstract

Section snippets

Patients

Results

Discussion

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