Pediatric Neck Injuries

OBJECTIVES

After completing this article, readers should be able to:

1. Describe where the fulcrum of movement of the spine progresses as the spine matures and how a child’s age can be related to the site of injury on the spinal cord.

2. Recognize the problem of serious spinal cord injury without radiologic abnormality in children, especially in those younger than 8 years of age.

3. Interpret pseudosubluxation of C2 over C3, the presence of ossification centers, and ligamentous laxity in pediatric cervical spine radiographs.

4. Identify the recommended initial management approach to spinal cord injuries.

5. Identify the type of delivery in which most cervical spine injuries are caused by birth trauma.

6. Explain why children who have Down syndrome are at increased risk of neurologic symptoms.

7. Describe atlantoaxial rotary subluxation, the condition with which it commonly presents, and the conditions with which it often is associated.

Introduction

Neck injuries may involve the nervous system, bone, ligaments, vasculature, muscles, or airway. The most serious and anxiety-provoking neck injuries involve potential damage to the spinal cord. Unique features of the pediatric spine create differences in the evaluation and treatment of neck injuries in children. For example, the fulcrum of movement is higher due to a larger head size, vertebrae may be incompletely ossified, ligamentous attachments may be stronger than bone, and articular surfaces are more horizontal. In addition, significant spinal cord injury may occur without radiologic abnormality in children, especially those younger than 8 years of age.

Epidemiology

Head injuries are far more common among children than spine injuries, and spine injuries are more frequent among adults than children. However, when children experience spinal injuries, they tend to be located in the cervical spine; up to 75% of spinal column injuries between infancy and age 8 years occur in the cervical spine. Between 8 and 14 years of …