Paediatric Cervical Spine: Difference between revisions
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* more horizontal facets | * more horizontal facets | ||
* flatter vertebral bodies | * flatter vertebral bodies | ||
* smaller occipital condyles | |||
* ligamentous laxity | * ligamentous laxity | ||
* unfused synchondroses | * unfused synchondroses | ||
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== Injuries == | == 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>. | 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>. Motor vehicle collisions are the predominant mechanism in younger children under 8 years old<ref name=":1" />. Older children most commonly sustain sports-related injuries<ref name=":1" />. | ||
Cervical spine injuries in younger 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" />. | |||
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" />. | |||
Above 8 years of age, cervical spine injuries usually occur in the lower cervical spine. | |||
Spinal cord injuries without radiologic abnormalities (SCIWORA) can occur due to the ligamentous elasticity and flexibility of the paediatric vertebral column which can withstand injuries without evidence of deformity. 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" />. | |||
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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
- smaller occipital condyles
- 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]. Motor vehicle collisions are the predominant mechanism in younger children under 8 years old[2]. Older children most commonly sustain sports-related injuries[2].
Cervical spine injuries in younger 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].
Above 8 years of age, cervical spine injuries usually occur in the lower cervical spine.
Spinal cord injuries without radiologic abnormalities (SCIWORA) can occur due to the ligamentous elasticity and flexibility of the paediatric vertebral column which can withstand injuries without evidence of deformity. 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].
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.
