Pediatric Cervical Spine Injuries

Abstract

Level IV.

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

“…Identifying children at risk of CSI is challenging, since physical examination can be unreliable [8]. In addition, trauma mechanisms in children differ from those in adults and are often associated with unique injury patterns, due to the anatomy of the paediatric cervical spine (C-spine) [5,9,10]. When clearing the C-spine in children, radiographic imaging is often used, despite this being costly and exposing children to radiation and its associated risks.…”

“…If CSI is suspected, various international trauma guidelines recommend plain radiography of the C-spine as primary imaging in children [11,16]. Its sensitivity for detecting CSI is higher than 90% [9,11,[17][18][19]. A CT scan of the C-spine is only indicated in those patients for whom a fracture is seen on plain radiography or for whom there is clinical suspicion of CSI despite a negative result with plain radiography [20][21][22].…”

Management of cervical spine trauma in children

“…Mortality was 33% in those with an upper cervical spine injury, versus 8.3% in lower cervical spine injury [1]. As with adults, males show a greater propensity to suffering cervical spine injury than females, at a ratio of 1.5–2.1:1 [2].…”

“…It was identified that if the child did not exhibit any of the five NEXUS criteria, then they did not have a cervical spine fracture [21]. However, only 2.8% of children in this study were under 2 years old and this group are the most difficult to assess in the emergency department [2].…”

Transoral Closed Reduction of Fixed Atlanto-Axial Rotatory-Subluxation (AARS) in Childhood and Adolescence

“…Atlanto-axial rotatory-subluxation (AARS) is the most common pediatric cervical spine injury, 1 – 7 and can be classified according to Fielding and Hawkins assessing the direction and extent of atlas rotation (Fig. 1 ).…”