Paediatric Cervical Spine

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Clinical Anatomy

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.”

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. 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%.

Motor vehicle collisions are the predominant mechanism in children under 8 years old. Older children most commonly sustain sports-related injuries. 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. 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. Unfused synchondroses, especially at the level of the dens, are susceptible to trauma and notoriously difficult to diagnose. 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.