Classification and Management of Pediatric Subaxial Cervical Spine Injuries

ACR Appropriateness Criteria® Suspected Spine Trauma-Child

“…In general, the diagnostic evaluation of children with traumatic spine injury is determined by clinical findings, such as pain, limitation of movements, and neurological deficits, as well as injury mechanisms (eg, high-versus low-energy trauma mechanisms) [6]. However, the clinical assessment of spine injuries in children may be limited in unconscious or intubated patients, in children with intellectual disabilities, and in children who lack the ability to communicate because of their developmental stage (typically <2 years of age) [7,8].…”

“…After the age of 8 years, spinal column development matures and most injuries involve the lower cervical spine [12]. Therefore, the diagnosis, workup, and management of cervical spinal trauma in children varies with age [6].…”

Pediatric Spine Trauma

“…Subaxial cervical spine injury mostly occurs between age 9 to 16 which reflects the fulcrum of cervical motion at C5-C6 for adolescents [ 9 , 25 ]. For children under the age 9, pure ligamentous injury with SCI is more common, whereas bony injuries are more common for older children [ 65 ]. The most important determinant of treatment depends on neurologic status and stability of the injury, and imaging plays a key role for the evaluation [ 25 , 70 ].…”

“…Denis’s three column model, originally developed for thoracolumbar injury [ 21 ], is also widely used to assess cervical spine stability [ 10 , 16 ], and Subaxial Cervical Spine Injury Classification (SLIC) system encompass treatment strategy with prognosis [ 53 , 79 , 97 , 98 ]. Generally, stable injuries are managed conservatively, and surgical intervention is considered for mechanically or neurologically unstable injuries with shortest construct as possible to avoid compromising spinal column growth [ 65 ]. Future cervical deformity would require surgical treatment based on the degree of malalignment, as cervical spine is in a dynamic relationship with whole spine which can influence global spinal balance [ 47 , 58 ].…”

“…Those who have objective finding of myelopathy from trauma, with negative plain radiographs, CT, and MRI are classified as SCIWORA, although some argue that this diagnosis can be made with cord signal change on MRI [ 16 , 52 ]. Most investigators advocate conservative treatment of cervical orthosis for up to 12 weeks followed by examining for late instability for SCIWORA [ 52 , 53 , 65 ]. And it is noteworthy that some consider the term SCIWORA a misnomer especially for adult population because they actually have baseline degenerative changes [ 88 ].…”