What a Pain in the Neck

Abstract

Cervical spine injuries are challenging to diagnose based on clinical assessment alone for even the most seasoned pediatric emergency medicine physician. Traumatic cervical spine injuries in the pediatric population are quite rare; however, when present they have the potential for devastating neurological outcomes. Unlike adults, no well validated clinical assessment tool exists for pediatric patients. When imaging is obtained, what may appear as pathologic to the unseasoned eye may in reality be a normal variant, non-pathological, or normal growth pattern. On the other hand, detection of cervical spine injuries may be very subtle, and in some cases can only be identified on MRI. Any child presenting with abnormal vital signs, altered mental status, or an abnormal neurological exam should be assumed to have a cervical spine injury. Maintaining cervical spine precautions and obtaining prompt imaging and specialist evaluation are indicated when stable and in the appropriate clinical setting.