Cervical Spine Trauma in Children: A Review

Todd Mccall, MD; Dan Fassett, MD; Douglas Brockmeyer, MD

Disclosures

Neurosurg Focus. 2006;20(2):E5 

In This Article

Causes of SCI

Injuries of the cervical spine[19,64] and spinal cord[28,48,78] in children are relatively infrequent compared with their occurrence in adults. Pediatric cases of cervical spine injury account for less than 10% of all such injuries,[50] and approximately 40 to 60% of all pediatric spine injuries occur in the cervical region.[40,41] Besides the ones associated with birth trauma, young children rarely incur fractures below C-2.[40,80] As children become older and their biomechanics more closely approximate those of adults, however, fractures more commonly occur in the lower cervical spine.[40]

Motor vehicle accidents are the most common cause of pediatric cervical injuries, but obstetrical complications, falls, sports, diving accidents, firearms, and child abuse account for many injuries as well.[5,19,53,60,91] As would be expected, the contribution of different mechanisms varies with the patient's age. In neonates, the leading cause of cervical injury is obstetrical complications.[91,96] Spinal cord injuries occur in one of 60,000 births,[100] with the upper cervical region most frequently involved.[59] Cardinal features of birth-related upper cervical SCI include apnea, flaccid quadriplegia, and injuries due to the use of forceps. Unfortunately, neonatal death is common with such injuries.[1,3] Birth-related cervical injuries are usually associated with a breech presentation,[12,15] although they can also occur with cephalic delivery.[87] Cervical injuries in infants and toddlers usually result from falls, motor vehicle accidents, and nonaccidental trauma.[37,38,93] Among children 3 to 10 years of age, falls, bicycle mishaps, and auto-pedestrian accidents account for most injuries,[44,80] and after the age of 10 years, sports and motor vehicle accidents are the biggest culprits.[40,52,53]

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