Pediatric subaxial cervical spine injuries: origins, management, and outcome in 51 patients

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In this study the authors evaluated the mechanisms and patterns of injury and the factors affecting management and outcome of pediatric subaxial cervical spine injuries (C3–7).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Fifty-one pediatric patients (38 boys and 13 girls; mean age 12.4 years, range 10 months–16 years) with subaxial cervical spine injuries were reviewed retrospectively. Motor vehicle accidents (MVAs) were the most common cause of injury. Overall, 12% presented with a dislocation, 63% with a fracture, 19% with a fracture–dislocation, and 6% with a ligamentous injury. The most frequently injured level was C6–7 (33%); C3–4 (6%) was least frequently involved. Sixty-four percent of patients were neurologically intact, 16% had incomplete spinal cord injuries (SCIs), 14% had complete SCIs, and three patients (6%) died after admission and before assessment. Treatment was conservative in 64%: seven (13%) wore a halo vest and 26 (51%) wore a rigid cervical orthosis. Surgery was performed in the other 18 patients (36%), with the breakdown as follows: 15 (30%) underwent an anterior approach, two (4%) had posterior approaches, and one (2%) had a combined approach. Postoperatively, four patients (8%) who had a neurological deficit improved. The overall mortality rate was 8%; all deaths were related to MVAs. There were no surgery-related deaths or complications.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Subaxial cervical spine injuries are common in children 9 to 16 years of age, and occur principally between C-5 and C-7. Multilevel injury is more common in children 8 years of age and older than in younger children and infants. Most patients with subaxial cervical spine injuries can be treated conservatively. Both anterior and posterior approaches are safe and effective.</jats:p></jats:sec>

Traumatic spinal injuries in children at a single level 1 pediatric trauma centre: report of a 23-year experience

“…1,8,10 In addition, young children seem to sustain more cervical spine injuries, whereas adolescents tend to sustain more thoracic and lumbar injuries. 15,16 In our study, the most common spine levels injured were the L2-sacrum followed by the O-C2 regions. An O-C2 spine injury was the leading cause of death in our study.…”

Surgical treatment for irreducible pediatric subaxial cervical unilateral facet dislocation: case report

“…5,6,10,14,18,21 Although several reports focus on fusion with instrumentation, 5,6,14,21 evidence suggests that cervical fusion causes complete loss of ROM in the involved segment and may lead to spontaneous fusion of adjacent joints or increase the rate of herniation on the superior disc. 15,19 As a consequence, fusion should only be applied when there is no alternative.…”

“…5,6,14,21 Here, we report a surgical approach for pediatric SCUFD that preserves ROM in the dislocated segment. We treated SCUFD at C3-4 in a 5-year-old boy.…”

“…In previous reports of pediatric SCUFD, conservative therapy and surgery were successful. 5,6,10,14,18,21 Most patients recovered well after management, and neurological symptoms disappeared. Only 1 patient experienced postoperative recurrence of dislocation and intervertebral instability.…”

“…13 The most common causes of pediatric subaxial CSI are motor vehicle accidents (50%) and sports-related activities (25%). 6 Optimal management and treatment strategies for pediatric SCUFD remain unclear. In previous reports of pediatric SCUFD, conservative therapy and surgery were successful.…”