Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts

Gopinathan, Nirmal Raj; Viswanathan, Vibhu Krishnan; Crawford, Alvin H.

doi:10.4103/ortho.ijortho_607_17

Cited by 36 publications

(17 citation statements)

References 92 publications

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“…Children with relatively large heads are prone to cervical flexion and extension injuries, leading to severe spinal injuries. [ 34 , 35 ] In addition, because of the laxity of spinal ligaments and neck muscles, a child’s spine is highly flexible, extending up to 5 cm, whereas the spinal cord can only extend to 5 mm. The spinal cord is relatively fixed in comparison to the range of motion of the spine.…”

Section: Discussionmentioning

confidence: 99%

A case report on a child with fracture and dislocation of the upper cervical spine accompanied by spinal cord injury

et al. 2022

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Rationale: This study describes an 8-year-old boy with a C2 fracture and dislocation with a left C2-C3 articular process interlocking and spinal cord injury who underwent open reduction and internal fixation using the posterior cervical approach and achieved satisfactory results.Patient concerns: An 8-year-old boy underwent an emergency transfer from a previous hospital after a car accident.Diagnoses: Axial fracture and dislocation with spinal cord injury (American Spinal Injury Association grade C), traumatic shock, brain contusion, intracranial hemorrhage, mandibular fracture, pulmonary contusion and hemorrhage, left vertebral artery stenosis, and multiple fractures throughout the body. Radiological examination revealed a fracture of the lower edge of the C2 vertebral body, fourth-degree anterior spondylolisthesis of the C2 vertebral body, interlocking of the left C2-C3 articular processes, widening of the C2-C3 vertebral space, and occlusion of the V1 and 2 segments of the left vertebral artery. Interventions:The boy was immediately intubated and transferred to the pediatric intensive care unit for rescue treatment. However, the reduction was unsuccessful with 2 weeks of cranial traction. Thus, an open reduction was performed under general anesthesia. One month after the surgery, the boy was discharged from the hospital on foot after rehabilitation treatment.Outcomes: The boy was discharged from the hospital 1 month after surgery. At the 8-month follow-up, a radiological examination showed that the corrected C2 vertebral body fracture and dislocation were satisfactorily reduced, and the spinal cord was adequately decompressed. The internal fixation position was also good, and the spinal sequence had recovered well. In summary, except for the muscle strength of the right upper limb, which was slightly worse, the other clinical symptoms were significantly improved.Lessons: In treating cervical fracture and dislocation with unilateral facet lock, the posterior open reduction of pedicle screw and lateral mass screw internal fixation achieved satisfactory results. Consequently, treating complex cervical spine injuries in children requires an accurate diagnosis and careful treatment strategy.

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Section: Discussionmentioning

confidence: 99%

A case report on a child with fracture and dislocation of the upper cervical spine accompanied by spinal cord injury

et al. 2022

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“…The relatively larger head size observed in children results in greater flexion and extension injuries and more serious spinal injury. [ 18 , 19 ] Moreover, the highly flexible pediatric spine has greater tolerability to motion. The unique features observed in the pediatric population include a more elastic spinal column, greater ligamentous laxity, and immaturity of neck musculature, greater flexibility.…”

Section: Discussionmentioning

confidence: 99%

Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome

et al. 2021

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Rationale: A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. Patient concerns: A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. Diagnosis: Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3–4. Interventions: The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. Outcomes: At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. Lessons: To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.

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“…Pediatric population studies usually evaluate patients in 3 age categories when considering spinal characteristics and symptoms evaluation: 0–3 years (noncommunicative group), 3–8 years (immature spine), and 9–17 years (older pediatric population) [11, 12]. Although immature spine characteristics are at the forefront in children under 9 years old, children over 15 years of age have features close to that of the adult spine [3].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Spinal Traumas

et al. 2020

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Introduction: Although childhood trauma is a major cause of morbidity and mortality, the incidence of spinal trauma is significantly lower in children than in adults. Existing studies on pediatric spinal trauma (PST) largely concern cervical trauma because of its frequency of incidence. We aimed to obtain more information by examining all types of spinal trauma, and evaluating factors such as age, trauma type, injury type, and American Spinal Injury Association score and comparing them with data from the literature. Methods: We retrospectively reviewed 30 pediatric trauma patients with spinal pathology confirmed by spinal imaging. Results: The mean age was 166.4 months. Mean age for each mechanism of injury was: 142.7 months for a simple fall, 149.0 months for injury involving a foreign object, 163.5 months for a fall from a height, and 181.6 months for traffic accidents. There was no statistically significant difference in mean age for different mechanisms of injury (p = 0.372). The levels of the spinal injuries were: lumbar 53.3% (16), thoracic 26.6% (8), and cervical 20.0% (6). Mean age for each level of spinal injury was 113.3 months for the cervical area, 172.2 months for the thoracic area, and 183.3 months for the lumbar area. Mean age was found to be statistically significant (p = 0.000). Discussion: PST is uncommon and the type of trauma and the spinal level affected varies with age. Cervical trauma predominates at younger ages, but adult-like traumas begin to occur with increasing age. It should be considered that the risk of developing neurological deficits is higher in pediatric patients than in adults, and the risk of multisystem injury is also high.

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Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts

Cited by 36 publications

References 92 publications

A case report on a child with fracture and dislocation of the upper cervical spine accompanied by spinal cord injury

A case report on a child with fracture and dislocation of the upper cervical spine accompanied by spinal cord injury

Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome

Pediatric Spinal Traumas

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