Epidemiology Incidence 2-5% of all spinal cord injuries 83% involve the cervical spine Demographics male:female ratio of approximately 1.5:1 cervical spine injuries more common in children <8 y/o due to large head-to-body ratio thoracolumbar spine injuries more common in children >8 y/o Anatomic location upper cervical spine injuries (C1-4) are more common than lower cervical spine injuries (C5-7) Etiology Pathophysiology mechanism of injury includes: login to view 5 more bullets Orthopedic considerations pattern of injury login to view 11 more bullets Associated conditions head injuries (>30%) intra-thoracic injuries intra-abdominal injuries Anatomy Spinal cord spinal cord ends at L3 in the newborn migrates cephalad during childhood to end at L1-L2 reaches adult size by 10 y/o Osteology vertebral bodies undergo chondrification around the 5th or 6th week of gestation ossification occurs throughout adolescence deforming forces are commonly translated through the relatively weak physeal cartilage of maturing vertebral bodies Biomechanics greater flexibility of the pediatric spinal column compared to adults is due to: login to view 4 more bullets Classification Pediatric Glasgow Coma Scale Best motor response login to view 6 more bullets Best verbal response login to view 5 more bullets Best eye opening login to view 4 more bullets Evaluation Primary survey formation of a multi-disciplinary pediatric trauma team assessment as per Advanced Trauma and Life Support (ATLS) protocol for children login to view 9 more bullets Secondary survey trauma specific history login to view 1 more bullet full neurologic examination login to view 3 more bullets physical examination login to view 3 more bullets Imaging Radiographs recommended views login to view 1 more bullet additional views login to view 4 more bullets findings login to view 4 more bullets CT indications login to view 5 more bullets findings login to view 2 more bullets MRI indications login to view 2 more bullets findings login to view 3 more bullets Treatment Nonoperative pain control and activity as tolerated login to view 5 more bullets activity modification and spinal immobilization login to view 18 more bullets Operative surgical stabilization of cervical spine login to view 8 more bullets surgical stabilization of thoracolumbar spine login to view 7 more bullets Complications Complete neurological deficits Progressive spinal deformity Poor wound healing with operative treatment Cauda equina syndrome Prognosis Natural history of disease most spinal cord injuries in children are incomplete all injuries need to be followed to maturity due to risk of spinal column deformities Neurologic injury spinal cord injury is more common/lethal in patients <8 y/o prognosis for recovery is better in patients >8 y/o