Peculiarities and Patterns of Cervical Spine Injuries in Children and Adolescents: A Retrospective Series of 84 Patients from a Single Institute

Abstract

Cervical spine injuries occur infrequently in children but are associated with significant disability and mortality. A retrospective analysis was performed of 84 consecutive pediatric spine injuries treated at our institute from January 2002 to December 2011. The mean age was 14.7 years. There were 18 patients (21%) in group A (0-12 years) and 66 patients (79%) in group B (13-18 years). Overall, injury was more common in boys (ratio of 6:1). Trivial fall was the predominant cause in group A and fall from height in group B. There were 30 children (36%) with injuries of the upper cervical spine, 53 (63%) with injuries of the lower cervical spine and 1 patient (1%) with a combined injury of upper cervical spine and thoracic spine. Overall, 22% of the group A children and 67% of the group B patients had more severe injuries (Frankel grades A, B and C); 21% (18/84) were treated by surgical fusion. Where follow-up was available, 17 out of 22 children (77%) had good outcome (Frankel grade >C). In conclusion, mechanisms and patterns of injury in children are age related and the majority of the children had good outcome.

Successful surgical repair and recovery in a 2-week-old infant after birth-related cervical fracture dislocation

“…Good postoperative follow-up has been associated with favorable outcomes after cervical trauma repair. 1 After successfully repairing the fracture and dislocation, our patient is walking and using his hands in part due to consistent physical and occupational therapy. He is speaking well and participating in school, despite his early oral aversion, due to regular speech therapy.…”

“…Although few cases of favorable outcomes of cervical dislocation after birth have been reported in the past, 10,11,24 the incidence of such an injury is deemed to be higher than reported. 1 In infants, the fulcrum of cervical spine movement is located at C1-3, leading to a majority of injuries in this region. Such injuries occur due to hyperflexion or hyperextension mechanisms.…”

Management of Orthopaedic Injuries in Multiply Injured Child

“…These differences cause unique patterns of injuries, and generally prognosis is better. 22 Children under 2 years of age rarely sustain bony cervical spine injury but are prone to cervical cord injury due to relative hypermobility of spine. Autopsies have shown that bony spinal column can withstand 2 inches of stretching, whereas neurovascular structures shear at a quarter of an inch stretch.…”

Feasibility of Anterior Fixation with Single Screw for Odontoid Fractures in Pediatrics: A Computed Tomographic Study

“…6 Nonoperative treatments, such as traction, reduction, and external orthosis, are common management options for type I odontoid fractures and achieve a high fusion rate. [7][8][9][10] However, for unstable and displaced fractures, such as type II and rostral type III fractures, surgical intervention is required to increase the fusion rate and avoid serious consequences, such as medullary compression and dynamic instability. 11,12 Compared to traditional surgeries, anterior screw fixation can preserve the normal range of atlantoaxial motion and has excellent fusion rates.…”

“…The classification of odontoid fractures given by Anderson and D'Alonzo is the most accepted 6 . Non‐operative treatments, such as traction, reduction, and external orthosis, are common management options for type I odontoid fractures and achieve a high fusion rate 7–10 . However, for unstable and displaced fractures, such as type II and rostral type III fractures, surgical intervention is required to increase the fusion rate and avoid serious consequences, such as medullary compression and dynamic instability 11,12 .…”