Paediatric Cervical Spine: Difference between revisions
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== Introduction == | == Introduction == | ||
Cervical spine injury (CSI) in children is unique in both the wide anatomic differences and the variety of mechanisms of injury. In children, the head is larger relative to the body, resulting in a higher center of gravity and fulcrum of neck motion; there are multiple vertebral ossification centers; and the ligamentous structures are lax<ref name=":2">Platzer P, Jaindl M, Thalhammer G, Dittrich S, Kutscha-Lissberg F, Vecsei V, Gaebler C. [https://www.ncbi.nlm.nih.gov/pubmed/17297330 Cervical spine injuries in pediatric patients]. Journal of Trauma and Acute Care Surgery. 2007 Feb 1;62(2):389-96.</ref>. Mechanisms of CSIs also differ between children and adults. Adults are injured predominantly in motor vehicle crashes and falls; children experience a broader range of traumatic events that place them at risk for CSIs<ref>Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC, Pediatric Emergency Care Applied Research Network, Cervical Spine Study Group. [http://pediatrics.aappublications.org/content/133/5/e1179 Cervical spine injury patterns in children]. Pediatrics. 2014 Apr 1:peds-2013.</ref>. | |||
== Clinical Anatomy == | == Clinical Anatomy == | ||
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== Injuries == | == Injuries == | ||
Although | Although CSI is uncommon in children, accounting for only 1–2% of paediatric trauma<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>, the clinical implications of failure to correctly diagnose CSI are significant. Spinal injuries in children are more likely and have significant consequences with permanent neurologic damage in up to 66% and mortality as high as 40%<ref name=":1" /><ref name=":2" />. | ||
Younger children have more injuries of the upper cervical spine, whereas children in the older age group sustain more injuries of the lower cervical spine<ref name=":2" />. Although motor vehicle accidents and falls are common in children, young children under 8 years of age are more vulnerable to pedestrian and inflicted injuries, whereas older children above 8 years of age most commonly sustain recreational and sports-related injuries<ref name=":1" /><ref name=":2" />. | |||
Cervical spine injuries in younger children are usually seen in the upper cervical region owing to the unique biomechanics and anatomy of the paediatric cervical spine<ref name=":0" />. Younger children have a relatively higher fulcrum with a larger head, predisposing to occipital cervical injures, with distraction and ligamentous injuries being 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" />. | |||
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 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, these are only seen in the younger age group<ref name=":2" />. | ||
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Introduction[edit | edit source]
Cervical spine injury (CSI) in children is unique in both the wide anatomic differences and the variety of mechanisms of injury. In children, the head is larger relative to the body, resulting in a higher center of gravity and fulcrum of neck motion; there are multiple vertebral ossification centers; and the ligamentous structures are lax[1]. Mechanisms of CSIs also differ between children and adults. Adults are injured predominantly in motor vehicle crashes and falls; children experience a broader range of traumatic events that place them at risk for CSIs[2].
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.”[3]
Injuries[edit | edit source]
Although CSI is uncommon in children, accounting for only 1–2% of paediatric trauma[4], the clinical implications of failure to correctly diagnose CSI are significant. Spinal injuries in children are more likely and have significant consequences with permanent neurologic damage in up to 66% and mortality as high as 40%[4][1].
Younger children have more injuries of the upper cervical spine, whereas children in the older age group sustain more injuries of the lower cervical spine[1]. Although motor vehicle accidents and falls are common in children, young children under 8 years of age are more vulnerable to pedestrian and inflicted injuries, whereas older children above 8 years of age most commonly sustain recreational and sports-related injuries[4][1].
Cervical spine injuries in younger children are usually seen in the upper cervical region owing to the unique biomechanics and anatomy of the paediatric cervical spine[3]. Younger children have a relatively higher fulcrum with a larger head, predisposing to occipital cervical injures, with distraction and ligamentous injuries being more common than bony injury[4]. Unfused synchondroses, especially at the level of the dens, are susceptible to trauma and notoriously difficult to diagnose[4]. 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[3].
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, these are only seen in the younger age group[1].
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Platzer P, Jaindl M, Thalhammer G, Dittrich S, Kutscha-Lissberg F, Vecsei V, Gaebler C. Cervical spine injuries in pediatric patients. Journal of Trauma and Acute Care Surgery. 2007 Feb 1;62(2):389-96.
- ↑ Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC, Pediatric Emergency Care Applied Research Network, Cervical Spine Study Group. Cervical spine injury patterns in children. Pediatrics. 2014 Apr 1:peds-2013.
- ↑ 3.0 3.1 3.2 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.
- ↑ 4.0 4.1 4.2 4.3 4.4 Booth TN. Cervical spine evaluation in pediatric trauma. American Journal of Roentgenology. 2012 May;198(5):W417-25.
