Paediatric Spine Injury

Spinal evaluation in the paediatric population is similar to those in adults.

Clinical and radiological evaluation of the immature anatomy requires particular care, with attention paid to X-ray variants.

Spinal cord injury without radiographic plain film abnormality is more common in this age group and a thorough neurological examination is important.

Initial Assessment of Spinal Trauma

Introduction
Spinal Stabilization
Clinical Clearance
Conscious Patients
Unconscious Patients
Thoracic & Lumbar Spine
Paediatric Spinal Injury

Immobilisation

Children have a disproportionately larger head size than adults, and when supine on a firm surface will be in a position of slight flexion. This slight degree of flexion is rarely a problem, though it can give rise to difficulties in X-ray interpretation. This can be corrected by placing a folded towel or sheet under the patient's shoulders to bring the cervical spine into the neutral position.

It may be difficult to immobilise a child adequately. Distress and discomfort may require that manual in-line stabilisation is used instead of a semi-rigid collar, blocks and tape. Collar sizing may be difficult and there are no collars that adequately fit infants aged 6 and below.

Clinical Clearance

Clinical clearance of the spine is less well established in the paediatric population. While the NEXUS study (Vicellio) has shown promise in this area, of 3065 patients there were only 4 cervical spine injuries in patients under 9 years of age, and none below 2 years old.

Radiology

The immature anatomy of the paediatric cervical spine requires some expertise and familiarity to interpret and to avoid missed injuries. Due to the paediatric patients' larger head size, pseudosubluxation of C2 on C3, and anterior translations may appear as injuries rather than as consequences of mild flexion.

Introduction

References

Baker C, Kadish H, Schunk JE. Evaluation of pediatric cervical spine injuries. Am J Emerg Med 17:230-4, 1999

Brown RL, Brunn MA, Garcia VF. Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg. 2001 Aug;36(8):1107-14

Curran C, Dietrich AM, Bowman MJ, Ginn-Pease ME, et al. Pediatric cervical-spine immobilization: achieving neutral position? J Trauma 39(4): 729-732, 1995

Herzenberg JE, Hensinger RN, Dedrick DK and Phillips WA. Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg [Am] 71(1): 15-22, 1989

Jaffe DM, Binns H, Radkowski MA, Barthel MJ, et al. Developing a clinical algorithm for early management of cervical spine injury in child trauma victims. Ann Emerg Med 16(3): 270-276, 1987

Keenan HT, Hollingshead MC, Chung CJ, Ziglar MK. Using CT of the cervical spine for early evaluation of pediatric patients with head trauma. AJR Am J Roentgenol. 2001 Dec;177(6):1405-9.

Kokoska ER, Keller MS, Rallo MC, Weber TR. Characteristics of pediatric cervical spine injuries. J Pediatr Surg. 2001 Jan;36(1):100-5.

Nitecki S and Moir CR. Predictive factors of the outcome of traumatic cervical spine fracture in children. J Pediatr Surg 29(11): 1409-1411, 1994

Patel JC, Tepas JJ 3rd, Mollitt DL, Pieper P. Pediatric cervical spine injuries: defining the disease. J Pediatr Surg. 2001 Feb;36(2):373-6

Rachesky I, Boyce WT, Duncan B, et al: Clinical prediction of cervical spine injuries in children. Radiographic abnormalities. Am J Dis Child 141:199-201, 1987

Skellett S, Tibby SM, Durward A, Murdoch IA. Immobilisation of the cervical spine in children. BMJ. 2002 Mar 9;324(7337):591-3

Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR. A prospective multicenter study of cervical spine injury in children. Pediatrics. 2001 Aug;108(2):E20.

Introduction

trauma.org (7:4) April 2002