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

Clinical Presentation

The possible presenting symptoms of a child with cervical spine trauma are highly variable. This type of trauma or SCI should be suspected if unconsciousness, torticollis, cervical rigidity, muscle guarding, neck pain, radicular pain, numbness, or history of transient or fixed neurological deficits is present. The most common symptom is pain, accompanied most frequently by focal midline tenderness. A stiff neck is often present and can impair adequate flexion and extension on radiographic studies. Pain that does not resolve within the first 1 or 2 weeks despite initially normal results on radiographs should raise concern that an injury has been overlooked and should be investigated further. Weakness and sensory changes, along with pain, may be radicular or myelopathic in nature. Autonomic disturbances are less common and can include bowel and bladder dysfunction. In the setting of acute trauma, hypotension without tachycardia should raise concern for severe SCI.[13]

Children are less likely than adults to suffer neurological injury with cervical spine trauma, although when neurological injury does ensue it often occurs with fracture-dislocations.[40,48] Facet dislocations are also associated with neurological sequelae. Bilateral dislocated facets generally affect the spinal cord, whereas a unilateral facet injury generally damages a nerve root. Injuries are often incomplete and some improvement can be expected, even late in the course of recovery.[40,80] Unfortunately, patients with complete SCIs normally do not recover.[18,44,62,75] Delayed progression of neurological deficits can also develop if initial instability is not discovered, which is more often a risk in cases of multiple trauma.[75,107]

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