Paediatric Cervical Spine: Difference between revisions

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== Introduction ==
== Introduction ==


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== Clinical Anatomy ==
   
There are several anatomical difference in the paediatric cervical spine that can influence injuries that may occur:
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* 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.”<ref name=":0">Lustrin ES, Karakas SP, Ortiz AO, Cinnamon J, Castillo M, Vaheesan K, Brown JH, Diamond AS, Black K, Singh S. [http://pubs.rsna.org/doi/abs/10.1148/rg.233025121 Pediatric cervical spine: normal anatomy, variants, and trauma]. Radiographics. 2003 May;23(3):539-60.</ref>
 
== Injuries ==
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<ref name=":1">Booth TN. [http://www.ajronline.org/doi/full/10.2214/AJR.11.8150 Cervical spine evaluation in pediatric trauma]. American Journal of Roentgenology. 2012 May;198(5):W417-25.</ref>. 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%<ref name=":1" />.
 
Motor vehicle collisions are the predominant mechanism in children under 8 years old<ref name=":1" />. Older children most commonly sustain sports-related injuries<ref name=":1" />.
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<ref name=":0" />. 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<ref name=":1" />. Unfused synchondroses, especially at the level of the dens, are susceptible to trauma and notoriously difficult to diagnose<ref name=":1" />. 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<ref name=":0" />.
 
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== References  ==
== References  ==


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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. 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. 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.