Elsevier

Journal of Pediatric Surgery

Volume 35, Issue 11, November 2000, Pages 1571-1575
Journal of Pediatric Surgery

Cervical spine trauma in the injured child: A tragic injury with potential for salvageable functional outcome☆

Presented at the 33rd Annual Meeting of the Pacific Association of Pediatric Surgeons, Las Vegas, Nevada, May 15-19, 2000.
https://doi.org/10.1053/jpsu.2000.18313Get rights and content

Abstract

Background/Purpose: Cervical spine injuries are uncommon in children, and, therefore, presumptive immobilization and diagnosis remain controversial. The purpose of this study was to review the author's experience with cervical spine injuries in children to determine the incidence, injury mechanism, pattern of injury, and subsequent functional outcome. Methods: Fifty-two children over a 6-year period (1994 to 1999) with a cervical spine injury secondary to blunt trauma were identified (1.3% incidence). The functional independent measure (FIM) was assessed at the time of discharge in each of 3 categories: communication, feeding, and locomotion. Results: Mean age of the study children was 10.7 ± 0.7 years. Eight children (15%) were less than 5 years old, and 4 (8%) were less than 2 years old. The mechanism of injury included motor vehicle crash (52%), falls (15%), bicycle accidents (11%), sports-related injuries (10%), pedestrian accidents (8%), and motorcycle crashes (4%). Seven patients died yielding an overall mortality rate of 13%. Injuries were distributed along the cervical spinal cord as follows: 5 atlanto-occipital dislocations, 28 C1 to C3 injuries, 17 C4 to C7 injuries, and 2 ligamentous injuries. FIM scores were recorded for 18 patients. Seventeen communicated independently, 14 fed themselves independently, and 12 had independent locomotive function. Conclusions: Cervical spine injuries occur in children across a spectrum of ages. Although atlanto-occipital dislocation is a highly lethal event, children with C1 to C7 injuries have a high likelihood of reasonable independent functioning. J Pediatr Surg 35:1571-1575. Copyright © 2000 by W.B. Saunders Company.

Section snippets

Patients

All patients less than 18 years of age admitted to the trauma service at The Children's Hospital (TCH) of Denver or Denver Health Medical Center (DHMC) with a radiographically documented cervical spine injury over a 6-year period (1994 through 1999) were identified by the trauma registry at each institution. Children with a penetrating mechanism of injury were excluded as were children with spinal cord injury without radiographic abnormality. The medical records were reviewed to confirm details

Results

The study population consisted of 52 children who had sustained cervical spine injury documented by physical examination and radiographic studies over the 6-year period ending December 1999. Twenty-nine of the patients were boys (56%), and they had a mean injury severity score of 22.5 ± 2.9. Mean age of the children sustaining cervical spine injuries was 10.7 ± 0.7 years with a wide range from 8 months old to 17 years old. Their age distribution is depicted in Fig 1.

. Age distribution of the

Discussion

There are substantial differences between children and adults in the clinical presentation as well as anatomy, diagnosis, and functional outcome for cervical spine injuries, especially for very young children.10 Previous investigators have documented that cervical spine injuries are uncommon in the pediatric trauma population.1, 2, 3 It is estimated that only 10% of spinal cord injuries occur in children.11, 12 Because these injuries are rare, the most appropriate and cost-effective means of

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☆

Address reprint requests to David A. Partrick, MD, The Children's Hospital, 1950 Ogden St, B-323, Denver, CO 80218.

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Copyright © 2000 W.B. Saunders Company. Published by Elsevier Inc. All rights reserved.