Paediatric Cervical Spine
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Introduction[edit | edit source]
Clinical Anatomy[edit | edit source]
There are several anatomical difference in the paediatric cervical spine that can influence injuries that may occur:
- more horizontal facets
- flatter vertebral bodies
- ligamentous laxity
- unfused synchondroses
- a relatively higher fulcrum with a larger head
Normal anatomic variants include pseudosubluxation, absence of cervical lordosis, wedging of the C3 vertebra, widening of the predental space, prevertebral soft-tissue widening, intervertebral widening, and “pseudo–Jefferson fracture.”[1]
Injuries[edit | edit source]
Although cervical spine injury (CSI) is uncommon in children, accounting for only 1–2% of pediatric trauma, the clinical implications of failure to correctly diagnose CSI are significant[2]. Spinal injuries in children are more likely and have significant consequences with permanent neurologic damage in up to 60% and mortality as high as 40%[2].
Motor vehicle collisions are the predominant mechanism in children under 8 years old[2]. Older children most commonly sustain sports-related injuries[2]. Cervical spine injuries in children are usually seen in the upper cervical region owing to the unique biomechanics and anatomy of the pediatric cervical spine[1]. Younger children have a relatively higher fulcrum with a larger head, predisposing to occipital cervical injures. Distraction and ligamentous injuries are more common than bony injury[2]. Unfused synchondroses, especially at the level of the dens, are susceptible to trauma and notoriously difficult to diagnose[2]. Knowledge of the normal embryologic development and anatomy of the cervical spine plus familiarity with anatomic variants is important to avoid mistaking synchondroses for fractures[1].
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Lustrin ES, Karakas SP, Ortiz AO, Cinnamon J, Castillo M, Vaheesan K, Brown JH, Diamond AS, Black K, Singh S. Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 2003 May;23(3):539-60.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Booth TN. Cervical spine evaluation in pediatric trauma. American Journal of Roentgenology. 2012 May;198(5):W417-25.