Cervical spine trauma in children: a review

McCall, Todd D.; Fassett, Daniel R.; Brockmeyer, Douglas L.

doi:10.3171/foc.2006.20.2.6

Cited by 75 publications

(53 citation statements)

References 98 publications

(108 reference statements)

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“…3,6 Moreover, the vertebral bodies are wedge shaped, ligaments are elastic, stabilizing muscles are weak and complex sensomotor coordination is slow. 4,7 The here additionally observed fracture of the odontoid process represents one of the most common cervical injury in pediatric patients.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

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Brook’s Wiring for Treatment of an Atlanto-Axial Dislocation and Odontoid Fracture in a Child

Schicho¹

2015

MOJCR

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IntroductionCervical spine injuries are rarely seen in children with an overall incidence of about 1-1.5%. 1,2 In pediatric cervical spine injury, the upper cervical spine is the most common site affected (52% of cases). 2The typical injury mechanisms for pediatric cervical spine injuries are hyper flexion movements as in motor vehicle accidents, because of distinct anatomic properties of a child's body, like an increased head-to-body ratio. 3,4 We here report the case of a 5-year-old boy, who sustained a severe hyperflexion trauma of the cervical spine in a highspeed car accident (approx. 60 mph). Computed tomography (CT) and magnetic resonance imaging (MRI) showed a complete atlanto-axial dislocation with synchondrotic fracture of the odontoid process. Case historyIn February 2013, a 5-year-old boy was a restrained passenger in a high-speed car crash with presumed high-force impact. Neither initial nor delayed unconsciousness were reported. He was responsive on scene, with neck pain and loss of head rotation. He was immobilized with stiff neck and spine-board and admitted to the emergency department of our hospital. DiagnosisExamination showed a glascow coma score (GCS) of 15 with pupils equal, round, reactive to light and accommodation. He was responsive and alert on scene but couldn't remember what has happened. The primary survey showed no disabilities or signs of head, chest, abdominal, pelvic or extremity injury. Both loss of head rotation and neck pain persisted. No abdominal damage aroused from sonographic assessment. We decided to perform a computed tomography (CT) of his head and neck to rule out intracerebral bleeding and fractures. Standard and 3D reconstructions revealed an atlanto-axial dislocation with a displacement of the atlas >5mm, a fracture of the odontoid process with a ventral axis tilt of 22° (Figure 1) and no signs of intracerebral bleeding. A following MRI scan Figure 2 showed ruptures of the interspinous ligaments from C2 to C6 with intact alar ligaments. The spinal cord showed no signs of damage. These findings lead to the diagnosis of an atlanto-axialdislocation with synchondrotic fracture of the odontoid process in a neurologically intact 5-year-old boy. AbstractBackground: Upper cervical spine injuries are rarely seen in children. Distinct anatomic properties make head and neck susceptible to hyperflexion movements.

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Section: Mechanism Of Injurymentioning

confidence: 99%

“…3,4 We here report the case of a 5-year-old boy, who sustained a severe hyperflexion trauma of the cervical spine in a highspeed car accident (approx. 60 mph).…”

mentioning

confidence: 99%

Brook’s Wiring for Treatment of an Atlanto-Axial Dislocation and Odontoid Fracture in a Child

Schicho¹

2015

MOJCR

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“…In adults, neck injuries are more likely to occur below C4 [2,4,9,11,20]. From the collected MRI data, a mathematical relationship between neck CSA and muscle CSA is proposed.…”

Section: Introductionmentioning

confidence: 99%

“…Due to an upward shift in the center of rotation of the neck of children as it flexes/extends [4,11,20] and due to their proportionately larger heads, child neck injuries tend to occur between the occiput and C4. In adults, neck injuries are more likely to occur below C4 [2,4,9,11,20].…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging-based relationships between neck muscle cross-sectional area and neck circumference for adults and children

et al. 2012

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Background Computer models and human surrogates used to study the forces and motion of the human neck under various loading conditions are based solely on adult data. Pediatric computer models and dummy surrogates used to improve the safety of children could be improved with the inclusion of previously unavailable pediatric muscle data. Methods Measurements of neck circumference and neck muscle cross-sectional area (CSA) were taken from ten 50th percentile adult male and ten 10-year old male volunteer subjects. Muscle cross-sectional areas were calculated from magnetic resonance images of axial cross-sections of the neck. Results Neck muscle cross-sectional area was calculated for six muscles/muscle groups. A power-law regression analysis was used to describe the relationship between neck circumference and neck muscle cross-sectional area. Conclusions The cross-sectional area and the power-law functions determined by the data in this study provide a means of calculating muscle cross-sectional area for young children, where such data are currently unavailable. This will provide an opportunity to develop more representative pediatric neck models.

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“…The fusion of the posterior synchondrosis first occurs at this age, and the anterior and posterior ossification centers join at this age as well [3]. These unique anatomical characters might cause more common pediatric upper cervical injury to 3 year-old children include occipitoaxial joint dislocation, atalantoaxial joint dislocation, atalantoaxial rotatory subluxation, and spinal injury without radiological abnormalities [4][5][6]. To better understand the cervical spine injury mechanism for 3-year-old children, it is necessary to develop finite element model with more anatomical and mechanical biofidelity.…”

Section: Introductionmentioning

confidence: 99%

Development and Tensile Investigation of a 3-year-old Cervical Spine Finite Element Model

Wei¹,

Zhang²,

Du³

et al. 2017

dtetr

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Abstract.A 3-year-old cervical spine finite element (FE) model with detailed anatomical and material properties was developed and validated against cadaver tests under dynamic loadings. First, the bone geometry was reconstructed based on high-resolution computed tomography (CT) scans, and the elastic-plastic material was defined to simulate the cortical and cancellous bones. Second, to simulate various ligament tears during dynamic tensile, ligaments failure were defined using force versus displacement curves, which had a sigmoidal shape governed by three control point. To better represent complicated structure of disc, such as nucleus pulposus, annulus fibrosus substrate and four pairs of reinforced fiber lamina, the intervertebral discs were defined using composite materials which combined by viscoelastic material, hill foam material and four pairs of reinforced fiber lamina, respectively. Finally, dynamic tensile experiments in C4-C5 and C0-C7 were used to validate the dynamic ultimate force and displacement of the 3-year-old cervical FE model, revealing that this FE model is capable of predicting intervertebral disc injury and ligament tear. This FE model will contribute to a better understanding of the mechanisms underlying pediatric cervical injuries.

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Cervical spine trauma in children: a review

Cited by 75 publications

References 98 publications

Brook’s Wiring for Treatment of an Atlanto-Axial Dislocation and Odontoid Fracture in a Child

Brook’s Wiring for Treatment of an Atlanto-Axial Dislocation and Odontoid Fracture in a Child

Magnetic resonance imaging-based relationships between neck muscle cross-sectional area and neck circumference for adults and children

Development and Tensile Investigation of a 3-year-old Cervical Spine Finite Element Model

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