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Cervical Spine Injuries

Now, fortunately, cervical spine injuries in kids are rare. They only happen in about 1- 2 percent of pediatric blunt trauma injuries. But, In children with cervical spine injuries, at least one in five have permanent neurologic deficits, and serious cervical spine injuries, there’s a 7 percent mortality rate. So severe mechanisms are the scenarios where you are most likely to see a C spine injury in kids.

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 A New PECARN Clinical Decision Rule Minimizes Unnecessary Imaging for Pediatric Cervical Spine Injuries

Figuring out which children need cervical spine imaging after blunt trauma can be a real challenge for even the most seasoned EMS and ED clinicians. We often end up extrapolating rules derived mainly in adults or using pediatric rules based on small retrospective analyses. Thanks to Dr. Leonard’s work, we now have a validated clinical prediction rule based on a large prospective pediatric study. It is exciting that this prediction rule, when used in clinical algorithms, could reduce the number of children receiving unnecessary radiographic testing and radiation exposure.

 How do I clear a pediatric C-Spine?

While c-spine injury in children is rare, children have some anatomical differences that make their c-spines prone to injury. NEXUS and Canadian C-Spine Rule cannot be used in children. PECARN study identified 8 risk factors...

 What a Pain in the Neck: C-spine Management in Pediatric Trauma

CSIs in children are typically seen in those with other significant blunt trauma or dangerous mechanism. C-spine injuries in kids are rare. Kids < 8 yo : C2-C3, Kids > 8 yo C5-C6. Generally can start with lateral neck +/- AP film, and odontoid view in older kids. Consider limited CT to C3 in younger children, especially if getting a head CT.

Articles of Interest

C-Spine in the Pediatric Trauma Patient

Describe key differences in the anatomy and pathophysiology of Cervical Spine Injuries (CSI) in children.

Pediatric Cervical Spine Injury

C-Spine clearance “Rules” for Adults do NOT fit all children well. The spinal column is more flexible than the spinal cord! Don’t overlook SCIWORA and those subtle neurologic symptoms.

Cervical Spinal Injury In Pediatric Blunt Trauma Patients: Management In The Emergency Department

Spinal injuries from blunt trauma are uncommon in pediatric patients, representing only about 1.5% of all blunt trauma patients. However, the potentially fatal consequences of spinal injuries make them of great concern to emergency clinicians. Clinical goals in the emergency department are to identify all injuries using selective imaging and to minimize further harm from spinal cord injury. Achieving these goals requires an understanding of the age-related physiologic differences that affect patterns of injury and radiologic interpretation in children, as well as an appreciation of high-risk clinical clues and mechanisms.

Cervical Spine Injuries in the Pediatric Population

Although cervical spine injuries are rare among the pediatric population, when you do see a child with a spinal injury, there's a 60-80% likelihood the c-spine is involved.

Cervical Spine Injury in Infants and Children

Cervical spine injuries occur in approximately 1.8% of pediatric blunt trauma patients. Although the incidence of cervical spine injuries in children is lower than adults (2.4%), children have higher rates of mortality (7.4%) compared to adults (1.2%). In children <8 years old, nearly three fourths of all spinal injuries occur in the cervical spine, and three fourths of the cervical spine injuries involve the axial cervical spine (occiput through C2).

Cervical Spine Injury Risk Factors in Children with Blunt Trauma

This is a pilot study in one of the PECARN network nodes that will be further investigated in the larger PECARN network. The study demonstrated the use of the rule could potentially decrease imaging usage by 20-25% at the expense of rarely missing patients with cervical spine injury (8-10% of those with CSI were not identified by the rules). However, none of the missed patients required a surgical intervention.

Current issues in the diagnosis of pediatric cervical spine injury

Cervical spine injury in pediatric trauma occurs rarely; however, there is significant potential for considerable morbidity when it does occur. Screening for cervical spine injuries has been shown to be most sensitive in adult trauma centers when combined with reliable physical examination findings. Because pediatric trauma patients suffer from a different range of injuries than adults, and often are not reliable due to age limitations or associated head injury, the same strategies employed in adult trauma do not always hold true in children.

Episode 30.0 – Pediatric C-spine Injuries

This episode delves into pediatric c-spine injuries focusing on the question of who needs imaging?

Management of cervical spine trauma in children

Paediatric cervical spine injuries are fortunately a rare entity. However, they do have the potential for devastating neurological sequelae with lifelong impact on the patient and their family. Thus, management ought to be exceptional from the initial evaluation at the scene of the injury, through to definitive management and rehabilitation.

Pediatric Cervical Spine Injuries

Pediatric cervical spine injuries are rare and account for 1 to 2% of all pediatric spine injuries. There is a paucity of data on pediatric cervical spine injuries in developing countries like India.

Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations

The discrepancies in current practices on the diagnostic and treatment strategies of paediatric CSIs can largely be attributed to a lack of standardized protocols (level I evidence). Future randomized controlled trials are needed to draw reliable conclusions on the optimum management of cervical spine trauma in children. In patients with SCIWORA MRI is necessary. MRI findings are in accord with the symptoms and predict neurologic outcome. A conservative treatment is suitable in most of those cases.

Pediatric Cervical Spine Injury and Immobilization

Trauma remains the number one killer of children in the United States. Luckily, pediatric spinal injuries are very rare. Of the pediatric spinal injuries that do occur, 60-80% are in the cervical spine.16 Overall, pediatric cervical spine injuries (CSIs) occur in 1-2% of pediatric blunt trauma. The most common mechanism of injury in those less than 2 years old by far were motor vehicle collisions (MVCs), followed by falls.

Pediatric Cervical Spine Injury Following Blunt Trauma in Children Younger Than 3 Years The PEDSPINE II Study

This study found wide clinical variability in the evaluation of pediatric trauma patients with increased use of cervical spine imaging. This has implications of increased cost, increased radiation exposure, and a potential for overdiagnosis. This prediction tool could help to decrease the use of imaging, aid in clinical decision-making, and decrease hospital resource use and cost.

Pediatric Cervical Spine Trauma

Pediatric cervical spine injuries are rare and are associated with significant morbidity and mortality. Pediatric anatomy and physiology predispose to upper cervical spine injury and spinal cord injury without radiologic abnormality in contrast to lower cervical spine injury seen in adults.

Spinal Injuries in Children

Spinal injuries are thankfully not common in children. Less than 2% of all children involved in major trauma will have a spinal injury. About 80% of these are high cervical injuries, compared to adults in whom thoracic or lumbar injuries are more common (70%) and in whom cervical injuries are more often the lower c-spine. The biggest cause of spinal injuries in children is road traffic collisions, particularly those with high speed, a rollover or an ejection from the vehicle, with second place going to falls in younger children and sporting injuries in older children.

Resources

StatPearls

Pediatric spine trauma presents unique challenges due to the anatomical and developmental differences in children compared to adults. One critical aspect is the flexibility and resilience of a child's spine, which can both aid and complicate management. Pediatric spinal injuries are relatively rare compared to adults, but they can have profound consequences if not managed appropriately. Additionally, pediatric patients may not always present with classic signs and symptoms of spinal cord injury, requiring a high index of suspicion for diagnosis.