Traumatic Cervical Spine Injuries in Childhood and Adolescence

Birney, Timothy J.; Hanley, Edward N.

doi:10.1097/00007632-198912000-00001

Cited by 88 publications

(34 citation statements)

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“…2,26 In our current series, this rate was lower (24%) than the findings in our previous report (40%). 13 It is also lower than the findings in other studies, which have ranged from 30 to 53%.…”

Section: Neurosurg Focus / Volume 20 / February 2006contrasting

confidence: 82%

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

Doğan¹,

Safavi–Abbasi²,

Theodore³

et al. 2006

FOC

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Object 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). Methods 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. Conclusions 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.

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Section: Neurosurg Focus / Volume 20 / February 2006contrasting

confidence: 82%

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

Doğan¹,

Safavi–Abbasi²,

Theodore³

et al. 2006

FOC

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“…The spinal cord and spinal column in the pediatric population are anatomically and biomechanically different from those in adults, and these differences predispose children to different mechanisms of injury (2)(3)(4)(5). In comparison with their adult counterparts, children with SCI tend to have a higher percentage of upper cervical and thoracic spine injuries (15-18), higher susceptibility to delayed onset of neurologic deficits (19), greater percentage of complete SCIs (20)(21)(22), and higher incidence of SCI without radiographic abnormality (SCIWORA) (23).…”

Section: Discussion Clinical Features Of Pediatric Scimentioning

confidence: 99%

“…The pediatric spinal cord and spinal column have anatomic and biomechanical differences compared with adults that predispose children to different mechanisms of injury and result in a unique injury profile (2)(3)(4)(5). A small number of pediatric animal models of SCI have been established and have been used primarily to investigate mechanisms of injury, repair, and regeneration.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Spinal Cord Injury in Infant Piglets: Description of a New Large Animal Model and Review of the Literature

Kuluz

Samdani

Benglis

et al. 2010

The Journal of Spinal Cord Medicine

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Objective: To develop a new, clinically relevant large animal model of pediatric spinal cord injury (SCI) and compare the clinical and experimental features of pediatric SCI. Methods: Infant piglets (3-5 weeks old) underwent contusive SCI by controlled cortical impactor at T7. Severe complete SCI was induced in 6 piglets, defined as SCI with no spontaneous return of sensorimotor function. Eight piglets received incomplete SCI, which was followed by partial recovery. Somatosensory evoked potentials, magnetic resonance imaging, neurobehavioral function, and histopathology were measured during a 28-day survival period. Results: Mean SCI volume (defined as volume of necrotic tissue) was larger after complete compared with incomplete SCI (387 ± 29 vs 77 ± 38 mm 3 , respectively, P , 0.001). No functional recovery occurred after complete SCI. After incomplete SCI, piglets initially had an absence of lower extremity sensorimotor function, urinary and stool retention, and little to no rectal tone. Sensory responses recovered first (1-2 days after injury), followed by spontaneous voiding, lower extremity motor responses, regular bowel movements, and repetitive flexion-extension of the lower extremities when crawling. No piglet recovered spontaneous walking, although 4 of 8 animals with incomplete injuries were able to bear weight by 28 days. In vivo magnetic resonance imaging was performed safely, yielded high-resolution images of tissue injury, and correlated closely with injury volume seen on histopathology, which included intramedullary hemorrhage, cellular inflammation, necrosis, and apoptosis. Conclusion: Piglets performed well as a reproducible model of traumatic pediatric SCI in a large animal with chronic survival and utilizing multiple outcome measures, including evoked potentials, magnetic resonance imaging, functional outcome scores, and histopathology.

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“…[1][2][3][4][5][6][7] The estimated annual incidence of pediatric cervical spine injuries is about 7 per 100,000 patients and around 1 per 100,000 patients for children less than 11 years of age. [1][2][3][4][5][6][7] When analyzing cervical spine injuries, the upper cervical vertebrae are more susceptible to trauma as compared to the subaxial levels. This is more than likely due to the fact that the head of the upper vertebrae are proportionately larger.…”

Section: Introductionmentioning

confidence: 99%

Halo-Vesting in Preschool Aged Children with Synchondrosis Fracture: A Case Series which Explores the Current Techniques Associated with this Procedure

Rahimizadeh¹,

Williamson²,

Rahimizadeh³

et al. 2017

Orthop Res Traumatol Open J

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Upper cervical spine injuries are the most common form of spinal cord trauma that occur in preschool children. Among such injuries, odontoid synchondrosis fractures are the most frequently observed, though relatively few cases have been reported in the medical literature. The most appropriate approach to describe such cases is physeal injuries of the basilar synchondrosis plate between the odontoid process and the body of the axis. Acute odontoid synchondrosis fractures are further classified into 3 subtypes based on the amount of dense displacement and the degree of fracture angulation. Type Ic, the most severe subtype, will require a posterior atlantoaxial fixation for an associated atlantoaxial subluxation. The majority of Type Ia and type Ib odontoid synchondrosis fractures that display only mild to moderate dense displacement and angulation, can be adequately addressed through proper fusion. Complete fusion may be achieved through external immobilization after careful alignment is reached by either Minerva Orthosis or the use of a Halo-vest. Regardless of the technique applied, prior to immobilization, acute synchondrosis fractures should be brought together through either neck hyperextension or by using the skull traction procedure. While Minerva orthosis has been effective in the treatment for two case series and a few case reports, the use of Halo-vesting in young children presents challenges due to decreased skull thickness and the presence of a certain amount of soft osseous tissue. For these reasons, a certain level of controversy exists in the medical literature as to whether the use of such a device is warranted. According to the opponents of this practice, Halo-vesting is often a frustrating and anxiety-provoking experience for young patients. They likewise draw attention to the concerns and hospitality anticipated from the caregivers of such children who have been vested. Furthermore, these authors document that Halo orthosis is associated with a higher percentage of complications such as pin site infections, pin loosening or dislodgement, the breakdown of skin, dysphagia, dural tears and even brain abscesses. Conversely, proponents believe that Halo-vesting is a well-tolerated procedure in a majority of children as well as in toddlers. In accordance with this belief, existing evidence demonstrates that with a modification in the pin number, pin design, location of insertion, and insertion torque, the incidence of pin dislodgement and pin loosening may be reduced. Moreover, pin-site infections can be prevented through periodic medical supervision of the child patient as well as educating caregivers on how to properly clean and monitor pin sites. Overall, the number of the children with odontoid synchondrosis fractures, who have been treated with Halo-vesting accounts for roughly 40 cases with a mean percentage of complication rate recorded at 40%. Herein, 3 young children with acute odontoid synchondrosis fractures are reported in whom solid fusion at the synchondrosis plate was achieved t...

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Traumatic Cervical Spine Injuries in Childhood and Adolescence

Cited by 88 publications

References 0 publications

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

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

Pediatric Spinal Cord Injury in Infant Piglets: Description of a New Large Animal Model and Review of the Literature

Halo-Vesting in Preschool Aged Children with Synchondrosis Fracture: A Case Series which Explores the Current Techniques Associated with this Procedure

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