Epidemiology Incidence pediatric cervical spine injuries are uncommon account for 60% of spinal injuries in the pediatric population 33% of pediatric patients with cervical spine injury will present with neurologic deficits Anatomic location at or above C3 87% of injuries at C3 or above in children <8 y/o below C3 beyond 8 y/o, lower cervical injuries are more common (adult-like injury patterns) Etiology Pathophysiology mechanism motor vehicle accidents login to view 2 more bullets falls login to view 1 more bullet sports related injuries login to view 1 more bullet pathoanatomy in patients younger than 8 y/o, the cervical spine is more susceptible to injury due to: login to view 5 more bullets Associated conditions neurologic injury 33% of patients will present with neurologic deficits solid organ involvement other organs may be involved in ~40% of patients with spinal trauma Anatomy Normal physiologic motion the pediatric spinal column can stretch up to 5 cm without rupture increased physiologic motion due to: horizontally oriented facet joints increased ligamentous laxity Presentation Physical exam complete exam critical because of a high incidence of associated injuries always suspect cervical spine injuries when patients present with head trauma and facial fractures careful neurologic exam need to document sensation (including sacral sparing), motor function, and presence of reflexes repeat exams are warranted as 20% of patients with spinal fractures may have normal examinations examinations can be difficult in unconscious patients Imaging Radiographs overview pediatric cervical spine imaging interpretation complicated by: login to view 4 more bullets radiographic findings that could be considered abnormal in an adult may be normal in a pediatric patient mandatory trauma radiographs include: AP odontoid open mouth cross-table lateral login to view 19 more bullets additional X-rays (optional) oblique login to view 1 more bullet flexion-extension login to view 1 more bullet CT scan useful to identify: fractures of upper cervical spine atlantoaxial rotatory subluxation can help to assess the degree of spinal canal compromise MRI indications useful in obtunded patients or patients with closed head injuries findings can help to assess the degree of spinal canal compromise Treatment Nonoperative initial immobilization indications login to view 1 more bullet modalities login to view 4 more bullets observation indications login to view 1 more bullet collar immobilization some common indications include: login to view 4 more bullets modalities login to view 1 more bullet halo immobilization some common indications include: login to view 6 more bullets surgical stabilization some common indications: login to view 3 more bullets Prognosis Mortality higher mortality rate at C3 or above injuries at C1 lead to a mortality rate of 17% injuries at C4 lead to a mortality rate of ~4% Neurologic injury spinal cord injury is more common/lethal in patients younger than 8 y/o prognosis for recovery is better in patients older than 8 y/o