Pediatric and Adolescent Cervical Spine Trauma



Cervical spine injury in children and adolescents is rare but presents a diagnostic challenge. Anatomic and radiographic differences between the pediatric and adult spine must be understood in order to differentiate injury from normal variant. Conditions predominantly seen in childhood, such as spinal cord injury without radiologic abnormality (SCIWORA), need to be aggressively sought. A formal policy for cervical spine clearance in children can help avoid unnecessary treatment and missed injuries. Injuries can be divided into upper cervical injury (cervical vascular injury, occipital condyle fractures, atlanto-occipital injuries, odontoid fractures, atlantoaxial rotary subluxation, fractures of C1 and C2) as well as subaxial injuries (fractures and dislocations). As in the adult, stable injuries are treated with immobilization, while unstable injuries require stabilization. An understanding of the relevant anatomy and surgical approaches to the treatment of these injuries in the growing child is crucial to provide effective treatment in this population.


Pediatric cervical spine SCIWORA Atlantoaxial rotatory subluxation Pediatric cervical spine clearance Pediatric cervical spine injury Pediatric cervical spine anatomy 


  1. 1.
    Jones TM, Anderson PA, Noonan KJ. Pediatric cervical spine trauma. J Am Acad Orthop Surg. 2011;19:600–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Vanderhave K, Chiravuri S, Caird M, Farley F, Graziano G, Hensinger R, Patel R. Cervical spine trauma in children and adults: perioperative vonsiderations. J Am Acad Orthop Surg. 2011;19:319–27.PubMedCrossRefGoogle Scholar
  3. 3.
    Mohseni S, Talving P, Branco BC, Chan LS, Lustenberger T, Inaba K, Bass M, Demetriades D. Effect of ages on cervical spine injury in pediatric population: a National Trauma Data Bank review. J Pediatr Surg. 2011;46(9):1771–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Eubanks J, Gilmore A, Bess S, Cooperman D. Clearing the pediatric cervical spine following injury. J Am Acad Orthop Surg. 2006;14:552–64.PubMedCrossRefGoogle Scholar
  5. 5.
    Rush JK, Kelly DM, Astur N, Creek A, Dawkins R, Younas S, et al. Associated injuries in children and adolescents with spinal trauma. J Pediatr Orthop. 2013;33(4):393–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Kokosa E, Keller M, Rallo M, Weber T. Characteristics of pediatric cervical spine injuries. J Pediatr Surg. 2001;36(1):100–5.CrossRefGoogle Scholar
  7. 7.
    McCall T, Fassett D, Brockmeyer D. Cervical spine trauma in children: a review. Neurosurg Focus. 2006;20(2):1–8.CrossRefGoogle Scholar
  8. 8.
    Kreykes NS, Letton RW Jr. Current issues in the diagnosis of pediatric cervical spine injury. Semin Pediatr Surg. 2010;19:257–64.PubMedCrossRefGoogle Scholar
  9. 9.
    Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 2004;55(6):1325–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Launay F, Leet AL, Sponseller PD. Pediatric spinal cord injury without radiographic abnormality: a meta-analysis. Clin Orthop Relat Res. 2005;433:166–70.CrossRefGoogle Scholar
  11. 11.
    Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN. Spinal injuries in children. J Pediatr Surg. 2004;39(4):607–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Carreon LY, Glassman SD, Campbell MJ. Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech. 2004;17(6):477–82.PubMedCrossRefGoogle Scholar
  13. 13.
    Leonard M, Sproule J, McCormack D. Paediatric spinal trauma and associated injuries. Injury. 2007;38:188–93.PubMedCrossRefGoogle Scholar
  14. 14.
    Asher MA, Jacobs RR. Pediatric thoracolumbar spine trauma. In: Bradford DS, Hensinger RN, editors. The pediatric spine. New York: Thieme; 1985. p. 105–17.Google Scholar
  15. 15.
    Crawford AH. Operative treatment of spine fractures in children. Orthop Clin North Am. 1990;21(2):325–39.PubMedGoogle Scholar
  16. 16.
    Lee JH, Sung IY, Kang JY, Park SR. Characteristics of pediatric-onset spinal cord injury. Pediatr Int. 2009;51(2):254–7.PubMedCrossRefGoogle Scholar
  17. 17.
    DeVivo MJ, Vogel LC. Epidemiology of spinal cord injury in children and adolescents. J Spinal Cord Med. 2004;27:S4–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Kewalramani LS, Tori JA. Spinal cord trauma in children. Neurologic patterns, radiologic features, and pathomechanics of injury. Spine (Phila Pa 1976). 1980;5(1):11–8.CrossRefGoogle Scholar
  19. 19.
    Ruge JR, Sinson GP, McLone DG, Cerullo LJ. Pediatric spinal injury: the very young. J Neurosurg. 1988;68(1):25–30.PubMedCrossRefGoogle Scholar
  20. 20.
    Puisto V, Kaarianen S, Impinen A, Parkkila T, Vartiainen E, Jalanko T, et al. Incidence of spinal and spinal cord injuries and their surgical treatment in children and adolescents: a population-based study. Spine (Phila Pa 1976). 2010;35(1):104–7.CrossRefGoogle Scholar
  21. 21.
    Vitale MG, Goss JM, Matsumoto H, Roye DP Jr. Epidemiology of pediatric spinal cord injury in the United States: years 1997 and 2000. J Pediatr Orthop. 2006;26:745–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Augutis M, Levi R. Pediatric spinal cord injury in Sweden: incidence, etiology, and outcome. Spinal Cord. 2003;41:328–36.PubMedCrossRefGoogle Scholar
  23. 23.
    Jones L. Birth trauma and the cervical spine. Arch Dis Child. 1970;15(1):55–64.Google Scholar
  24. 24.
    Podolsky S, Baraff LJ, Simon RR, Hoffman JR, Larmon B, Ablon W. Efficacy of cervical spine immobilization methods. J Trauma. 1983;23:461–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Buhs C, Cullen M, Klein M, Farmer D. The pediatric trauma C-spine: is the ‘odontoid’ view necessary? J Pediatr Surg. 2000;35(6):994–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Hernandez JA, Chupik C, Swischuk LE. Cervical spine trauma in children under 5 years: productivity of CT. Emerg Radiol. 2004;10(4):176–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Carlan D, Bradbury T, Green N, et al. The efficacy of helical CT versus conventional radiography of the cervical spine in pediatric trauma. Abstract. Pediatric Orthopedic Society of North America Annual meeting. Albuquerque; 2008.Google Scholar
  28. 28.
    Keenan HT, Hollingshead MC, Chung CJ, Ziglar MK. Using CT of the cervical spine for early evaluation of pediatric patients with head trauma. Am J Radiol. 2001;177:1405–9.Google Scholar
  29. 29.
    Brockmeyer DL, Ragel BT, Kestle JR. The pediatric cervical spine instability study. A pilot study assessing the prognostic value of four imaging modalities in clearing the cervical spine with severe traumatic injuries. Childs Nerv Syst. 2012;28(5):699–705.PubMedCrossRefGoogle Scholar
  30. 30.
    Henry M, Scarlata K, Riesenburger RI, Kryzanski J, Rideout L, Samdani A, et al. Utility of STIR MRI in pediatric cervical spine clearance after trauma. J Neurosurg Pediatr. 2013;12(1):1333–8.CrossRefGoogle Scholar
  31. 31.
    Frank J, Lim C, Flynn J, Dormans J. The efficacy of magnetic resonance imaging in pediatric cervical spine clearance. Spine. 2002;27(11):1176–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Hutchings L, Willett K. Cervical spine clearance in pediatric trauma: a review of current literature. J Trauma. 2009;67(4):687–91.PubMedCrossRefGoogle Scholar
  33. 33.
    Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Pieretti-Vanmarcke R, Velmahos GC, Nance ML, Islam S, Falcone RA Jr, Wales PW, et al. Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: a multi-center study of the American Association for the Surgery of Trauma. J Trauma. 2009;67(3):543–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Lee SL, Sena M, Greenholz SK, Fledderman M. A multidisciplinary approach to the development of a cervical spine clearance protocol: process, rationale, and initial results. J Pediatr Surg. 2003;38(3):358–62.PubMedCrossRefGoogle Scholar
  36. 36.
    Cook BS, Fanta K, Schweer L. Pediatric cervical spine clearance: implications for nursing practice. J Emerg Nurs. 2003;29(4):1–4.CrossRefGoogle Scholar
  37. 37.
    Tolhurst SR, Vanderhave KL, Caird MS, Garton HL, Graziano GP, Maher CO, et al. Cervical arterial injury after blunt trauma in children: characterization and advanced imaging. J Pediatr Orthop. 2013;33(1):37–42.PubMedCrossRefGoogle Scholar
  38. 38.
    Kapapa T, Tschan CA, Konig K, Schlesinger A, Haubitz B, Becker H, et al. Fracture of the occipital condyle caused by minor trauma in child. J Pediatr Surg. 2006;41(10):1774–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Momjian S, Dehdashti AR, Kehrli P, May D, Rilliet B. Occipital condyle fractures in children. Case report and review of the literature. Pediatr Neurosurg. 2003;38(5):265–70.PubMedCrossRefGoogle Scholar
  40. 40.
    Strehle EM, Tolinov V. Occipital condylar fractures in children: rare or underdiagnosed? Dentomaxillofac Radiol. 2012;41(2):175–6.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Anderson PA, Montesano PX. Morphology and treatment of occipital condyle fractures. Spine (Phila Pa 1976). 1988;13(7):731–6.CrossRefGoogle Scholar
  42. 42.
    Tuli S, Tator CH, Fehlings MG, Mackay M. Occipital condyle fractures. Neurosurgery. 1997;41(2):368–76; discussion 376–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Kenter K, Worley G, Griffin T, Fitch RD. Pediatric traumatic atlanto-occipital dislocation: five cases and a review. J Pediatr Orthop. 2001;21(5):585–9.PubMedGoogle Scholar
  44. 44.
    Steinmetz MP, Lechner RM, Anderson JS. Atlantooccipital dislocation in children: presentation, diagnosis, and management. Neurosurg Focus. 2003;14(2):ecp1.PubMedCrossRefGoogle Scholar
  45. 45.
    Kaufman RA, Carroll CD, Buncher CR. Atlantooccipital junction: standards for measurement in normal children. AJNR Am J Neuroradiol. 1987;8(6):995–9.PubMedGoogle Scholar
  46. 46.
    Kaufman RA, Dunbar JS, Botsford JA, McLaurin RL. Traumatic longitudinal atlanto-occipital distraction injuries in children. AJNR Am J Neuroradiol. 1982;3(4):415–9.PubMedGoogle Scholar
  47. 47.
    Lee C, Woodring JH, Goldstein SJ, Daniel TL, Young AB, Tibbs PA. Evaluation of traumatic atlantooccipital dislocations. AJNR Am J Neuroradiol. 1987;8(1):19–26.PubMedGoogle Scholar
  48. 48.
    Powers B, Miller MD, Kramer RS, Martinez S, Gehweiler JA Jr. Traumatic anterior atlanto-occipital dislocation. Neurosurgery. 1979;4(1):12–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Sun PP, Poffenbarger GJ, Durham S, Zimmerman RA. Spectrum of ccipitoatlantoaxial injury in young children. J Neurosurg. 2000;93(1 Suppl):28–39.PubMedGoogle Scholar
  50. 50.
    Wholey MH, Bruwer AJ, Baker HL Jr. The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology. 1958;71(3):350–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation: part 1--normal occipital condyle-C1 interval in 89 children. Neurosurgery. 2007;61(3):514–21; discussion 521.PubMedCrossRefGoogle Scholar
  52. 52.
    Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation–part 2: the clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery. 2007;61(5):995–1015; discussion 1015.PubMedCrossRefGoogle Scholar
  53. 53.
    Gluncic V, Turner M, Kranzler L, Frim D. Timely recognition of traumatic atlanto-occipital dislocation in a child based on occipital condyle-C1 interval analysis: excellent neurological recovery. J Neurosurg Pediatr. 2010;5(5):465–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Lustrin ES, Karakas SP, Ortiz AO, Cinnamon J, Castillo M, Vaheesan K, et al. Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 2003;23(3):539–60.PubMedCrossRefGoogle Scholar
  55. 55.
    Avellino AM, Mann FA, Grady MS, Chapman JR, Ellenbogen RG, Alden TD, et al. The misdiagnosis of acute cervical spine injuries and fractures in infants and children: the 12-year experience of a level I pediatric and adult trauma center. Childs Nerv Syst. 2005;21(2):122–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Marlin AE, Williams GR, Lee JF. Jefferson fractures in children. Case report. J Neurosurg. 1983;58(2):277–9.PubMedCrossRefGoogle Scholar
  57. 57.
    McGrory BJ, Klassen RA, Chao EY, Staeheli JW, Weaver AL. Acute fractures and dislocations of the cervical spine in children and adolescents. J Bone Joint Surg Am. 1993;75(7):988–95.PubMedCrossRefGoogle Scholar
  58. 58.
    Ames CP, Acosta F, Nottmeier E. Novel treatment of basilar invagination resulting from an untreated C-1 fracture associated with transverse ligament avulsion. Case report and description of surgical technique. J Neurosurg Spine. 2005;2(1):83–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Copley LA, Dormans JP. Cervical spine disorders in infants and children. J Am Acad Orthop Surg. 1998;6(4):204–14.PubMedCrossRefGoogle Scholar
  60. 60.
    Khanna G, El-Khoury GY. Imaging of cervical spine injuries of childhood. Skelet Radiol. 2007;36(6):477–94.CrossRefGoogle Scholar
  61. 61.
    Fassett DR, McCall T, Brockmeyer DL. Odontoid synchondrosis fractures in children. Neurosurg Focus. 2006;20(2):E7.PubMedGoogle Scholar
  62. 62.
    Odent T, Langlais J, Glorion C, Kassis B, Bataille J, Pouliquen JC. Fractures of the odontoid process: a report of 15 cases in children younger than 6 years. J Pediatr Orthop. 1999;19(1):51–4.PubMedGoogle Scholar
  63. 63.
    Hosalkar HS, Greenbaum JN, Flynn JM, Cameron DB, Dormans JP, Drummond DS. Fractures of the odontoid in children with an open basilar synchondrosis. J Bone Joint Surg Br. 2009;91(6):789–96.PubMedCrossRefGoogle Scholar
  64. 64.
    Fulkerson DH, Hwang SW, Patel AJ, Jea A. Open reduction and internal fixation for angulated, unstable odontoid synchondrosis fractures in children: a safe alternative to halo fixation? J Neurosurg Pediatr. 2012;9(1):35–41.PubMedCrossRefGoogle Scholar
  65. 65.
    Choit RL, Jamieson DH, Reilly CW. Os odontoideum: a significant radiographic finding. Pediatr Radiol. 2005;35(8):803–7.PubMedCrossRefGoogle Scholar
  66. 66.
    Fielding JW, Hensinger RN, Hawkins RJ. Os odontoideum. J Bone Joint Surg Am. 1980;62(3):376–83.PubMedCrossRefGoogle Scholar
  67. 67.
    Anonymous. Os odontoideum. Neurosurgery. 2002;50(3 Suppl):S148–55.Google Scholar
  68. 68.
    McGoldrick JM, Marx JA. Traumatic central cord syndrome in a patient with Os odontoideum. Ann Emerg Med. 1989;18(12):1358–61.PubMedCrossRefGoogle Scholar
  69. 69.
    Dempster AG, Heap SW. Fatal high cervical spinal cord injury in an automobile accident complicating os odontoideum. Am J Forensic Med Pathol. 1990;11(3):252–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Sasaki H, Itoh T, Takei H, Hayashi M. Os odontoideum with cerebellar infarction: a case report. Spine (Phila Pa 1976). 2000;25(9):1178–81.CrossRefGoogle Scholar
  71. 71.
    Wang J, Vokshoor A, Kim S, Elton S, Kosnik E, Bartkowski H. Pediatric atlantoaxial instability: management with screw fixation. Pediatr Neurosurg. 1999;30(2):70–8.PubMedCrossRefGoogle Scholar
  72. 72.
    Gluf WM, Brockmeyer DL. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients. J Neurosurg Spine. 2005;2(2):164–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Reilly CW, Choit RL. Transarticular screws in the management of C1-C2 instability in children. J Pediatr Orthop. 2006;26(5):582–8.PubMedCrossRefGoogle Scholar
  74. 74.
    Heuer GG, Hardesty DA, Bhowmick DA, Bailey R, Magge SN, Storm PB. Treatment of pediatric atlantoaxial instability with traditional and modified Goel-Harms fusion constructs. Eur Spine J. 2009;18(6):884–92.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Kleinman PK, Shelton YA. Hangman’s fracture in an abused infant: imaging features. Pediatr Radiol. 1997;27(9):776–7.PubMedCrossRefGoogle Scholar
  76. 76.
    McGrory BE, Fenichel GM. Hangman’s fracture subsequent to shaking in an infant. Ann Neurol. 1977;2(1):82.PubMedCrossRefGoogle Scholar
  77. 77.
    Ranjith RK, Mullett JH, Burke TE. Hangman’s fracture caused by suspected child abuse. A case report. J Pediatr Orthop B. 2002;11(4):329–32.PubMedGoogle Scholar
  78. 78.
    Ruff SJ, Taylor TK. Hangman’s fracture in an infant. J Bone Joint Surg Br. 1986;68(5):702–3.PubMedGoogle Scholar
  79. 79.
    Williams JP 3rd, Baker DH, Miller WA. CT appearance of congenital defect resembling the Hangman’s fracture. Pediatr Radiol. 1999;29(7):549–50.PubMedCrossRefGoogle Scholar
  80. 80.
    van Rijn RR, Kool DR, de Witt Hamer PC, Majoie CB. An abused five-month-old girl: hangman’s fracture or congenital arch defect? J Emerg Med. 2005;29(1):61–5.PubMedCrossRefGoogle Scholar
  81. 81.
    Pizzutillo PD, Rocha EF, D’Astous J, Kling TF Jr, McCarthy RE. Bilateral fracture of the pedicle of the second cervical vertebra in the young child. J Bone Joint Surg Am. 1986;68(6):892–6.PubMedCrossRefGoogle Scholar
  82. 82.
    Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. Fixed rotatory subluxation of the atlanto-axial joint. J Bone Joint Surg Am. 1977;59(1):37–44.PubMedCrossRefGoogle Scholar
  83. 83.
    Phillips WA, Hensinger RN. The management of rotatory atlanto-axial subluxation in children. J Bone Joint Surg Am. 1989;71(5):664–8.PubMedCrossRefGoogle Scholar
  84. 84.
    Pang D, Li V. Atlantoaxial rotatory fixation: part 1–biomechanics of normal rotation at the atlantoaxial joint in children. Neurosurgery. 2004;55(3):614–25; discussion 625–6.PubMedCrossRefGoogle Scholar
  85. 85.
    Pang D, Li V. Atlantoaxial rotatory fixation: part 2–new diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging. Neurosurgery. 2005;57(5):941–53; discussion 941–53.PubMedCrossRefGoogle Scholar
  86. 86.
    Pang D, Li V. Atlantoaxial rotatory fixation: part 3--a prospective study of the clinical manifestation, diagnosis, management, and outcome of children with alantoaxial rotatory fixation. Neurosurgery. 2005;57(5):954–72; discussion 954–72.PubMedCrossRefGoogle Scholar
  87. 87.
    Subach BR, McLaughlin MR, Albright AL, Pollack IF. Current management of pediatric atlantoaxial rotatory subluxation. Spine (Phila Pa 1976). 1998;23(20):2174–9.CrossRefGoogle Scholar
  88. 88.
    Lee SC, Lui TN, Lee ST. Atlantoaxial rotatory subluxation in skeletally immature patients. Br J Neurosurg. 2002;16(2):154–7.PubMedCrossRefGoogle Scholar
  89. 89.
    Henrys P, Lyne ED, Lifton C, Salciccioli G. Clinical review of cervical spine injuries in children. Clin Orthop Relat Res. 1977;129:172–6.CrossRefGoogle Scholar
  90. 90.
    McPhee B. Spinal fractures and dislocations in children and adolescents. Spine (Phila Pa 1976). 1981;6:533–7.CrossRefGoogle Scholar
  91. 91.
    Pennecot GF, Leonard P, Peyrot Des Gachons S, Hardy JR, Pouliquen JC. Traumatic ligamentous instability of the cervical spine in children. J Pediatr Orthop. 1984;4:339–45.PubMedCrossRefGoogle Scholar
  92. 92.
    Evans DL, Bethem D. Cervical spine injuries in children. J Pediatr Orthop. 1989;9:563–8.PubMedCrossRefGoogle Scholar
  93. 93.
    Birney TJ, Hanley EN. Traumatic cervical spine injuries in childhood and adolescence. Spine (Phila Pa 1976). 1989;14:277–82.CrossRefGoogle Scholar
  94. 94.
    Osenbach RK, Menezes AH. Pediatric spinal cord and vertebral column injury. Neurosurgery. 1992;30:385–90.PubMedCrossRefGoogle Scholar
  95. 95.
    McGrory BJ, Klassen RA, Chao EYS, Staeheli JW, Weaver AL. Acute fractures and dislocations of the cervical spine in children and adolescents. J Bone Joint Surg Am. 1993;75:988–95.PubMedCrossRefGoogle Scholar
  96. 96.
    Nitecki S, Moir CR. Predictive factors of the outcome of traumatic cervical spine fractures in children. J Pediatr Surg. 1994;29:1409–11.PubMedCrossRefGoogle Scholar
  97. 97.
    Finch GE, Barnes MJ. Major cervical spine injuries in children and adolescents. J Pediatr Orthop. 1998;18:811–4.PubMedGoogle Scholar
  98. 98.
    Eleraky MA, Theodore N, Adams M, Rekate HL, Sonntag V. Pediatric cervical spine injuries: report of 102 cases and review of the literature. J Neurosurg (Spine 1). 2000;92:12–7.CrossRefGoogle Scholar
  99. 99.
    Patrick DA, Bensard DD, Moore EE, Calkins CM, Karrer FM. Cervical spine trauma in the injured child: a tragic injury with potential for salvageable functional outcome. J Pediatr Surg. 2000;35:1571–5.CrossRefGoogle Scholar
  100. 100.
    Patel JC, Tepas JJ, Mollitt DL, Pieper P. Pediatric cervical spine injuries: defining the disease. J Pediatr Surg. 2001;36:373–6.PubMedCrossRefGoogle Scholar
  101. 101.
    Brown RL, Brunn MA, Garcia VF. Cervical spine injuries in children: a review of 103 patients treated consecutively at a level I pediatric trauma center. J Pediatr Surg. 2001;36:1107–14.PubMedCrossRefGoogle Scholar
  102. 102.
    Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR. A prospective study of cervical spine injury in children. Pediatrics. 2001;108:1–6.CrossRefGoogle Scholar
  103. 103.
    Bilstron LE, Brown J. Pediatric spinal injury type and severity are age and mechanism dependent. Spine (Phila Pa 1976). 2007;32:2339–47.CrossRefGoogle Scholar
  104. 104.
    Dogan S, Abbasi SS, Theodore N, Horns E, Rekate HL, Sonntag VKH. Pediatric subaxial cervical spine injuries: origins, management, and outcome in 51 patients. Neurosurg Focus. 2006;20:1–7.CrossRefGoogle Scholar
  105. 105.
    Allen BL, Ferguson RL, Lehmann TR, O’Brien RP. A mechanistic classification of closed indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982;7:1–27.CrossRefGoogle Scholar
  106. 106.
    Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA Jr, et al. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976). 2007;32(2):2365–74.CrossRefGoogle Scholar
  107. 107.
    Hall RDM. Clay-shoveler’s fracture. J Bone Joint Surg Am. 1940;22:63–75.Google Scholar
  108. 108.
    Lovell WW, Winter RB, Morrissy RT, et al. Lovell and Winter’s pediatric orthopaedics. 6th ed. Philadelphia: Lippincott, Williams and Wilkins; 2006. p. xi, 1545, I-42.Google Scholar
  109. 109.
    Bailey DK. The normal cervical spine in infants and children. Radiology. 1952;59:712–9.PubMedCrossRefGoogle Scholar
  110. 110.
    Yamaguchi KT, Myung KS, Alonso MA, Skaggs DL. Clay-shoveler’s fracture equivalent in children. Spine (Phila Pa 1976). 2012;37:E1672–5.CrossRefGoogle Scholar
  111. 111.
    Matar LD, Helms CA, Richardson WJ. Spinolaminar breach: an important sign in cervical spinous process fractures. Skelet Radiol. 2000;29:75–80.CrossRefGoogle Scholar
  112. 112.
    Hill SA, Miller CA, Kosnik EJ, Hunt WE. Pediatric neck injuries: a clinical study. J Neurosurg. 1984;60:700–6.PubMedCrossRefGoogle Scholar
  113. 113.
    White AA, Panjabi MM. Clinical biomechanics of the spine. 2nd ed. Philadelphia: JB Lippincott; 1990.Google Scholar
  114. 114.
    Dvorak MF, Fisher CG, Fehlings MG, Rampersaud YR, Oner FC, Aarabi B, et al. The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine (Phila Pa 1976). 2007;32(23):2620–9.CrossRefGoogle Scholar
  115. 115.
    Kwon BK, Vaccaro AR, Grauer JN, Fisher CG, Dvorak MF. Subaxial cervical spine trauma. J Am Acad Orthop Surg. 2006;14:78–89.PubMedCrossRefGoogle Scholar
  116. 116.
    Fisher CG, Dvorak MF, Leith J, Wing PC. Comparison of outcomes for unstable lower cervical flexion teardrop fractures managed with halo thoracic vest versus anterior corpectomy and plating. Spine. 2002;27:160–6.PubMedCrossRefGoogle Scholar
  117. 117.
    Koivikko MP, Myllyen P, Karjalainen M, Vornanen M, Santavirta S. Conservative and operative treatment in cervical burst fracture. Arch Orthop Trauma Surg. 2000;120:448–51.PubMedCrossRefGoogle Scholar
  118. 118.
    Cotler JM, Herbison GJ, Nasuti JF, Ditunno JF, An H, Wolff BE. Closed reduction of traumatic cervical spine dislocation using traction weights up to 140 pounds. Spine (Phila Pa 1976). 1993;18:386–90.CrossRefGoogle Scholar
  119. 119.
    Hart RA, Vaccaro AR, Nachwalter RS. Cervical facet dislocations: when is magnetic resonance imaging indicated? Spine (Phila Pa 1976). 2002;27:116–7.CrossRefGoogle Scholar
  120. 120.
    Vaccaro AR, Falatyn SP, Flanders AE, Balderston RA, Northrup BE, Cotler JM. Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed reduction of cervical spine dislocations. Spine (Phila Pa 1976). 1999;24:1210–7.CrossRefGoogle Scholar
  121. 121.
    Rorabeck CH, Rock MG, Hawkins RJ, Bourne RB. Unilateral facet dislocation of the cervical spine: an analysis of the results of treatment in 26 patients. Spine (Phila Pa 1976). 1987;12:23–7.CrossRefGoogle Scholar
  122. 122.
    Shapiro S, Snyder W, Kaufman K, Abel T. Outcome of 51 cases of unilateral locked cervical facets: interspinous braided cable for lateral mass plate fusion compared to interspinous wire and facet wiring with iliac crest. J Neurosurg. 1999;91(1 Suppl):19–24.PubMedGoogle Scholar
  123. 123.
    Dvorak M, Vaccaro AR, Hernsmeyer J, Norvell DC. Unilateral facet dislocations: is surgery really the preferred option? Evid Based Spine Care J. 2010;1:57–65.PubMedPubMedCentralCrossRefGoogle Scholar
  124. 124.
    Pang D, Wilberger JE. Spinal cord injury without radiographic abnormalities in children. J Neurosurg. 1982;57:114–29.PubMedCrossRefGoogle Scholar
  125. 125.
    Bosch PP, Vogt MT, Ward T. Pediatric spinal cord injury without radiographic abnormality (SCIWORA). The absence of occult instability and lack of indication for bracing. Spine (Phila Pa 1976). 2002;27:2788–800.CrossRefGoogle Scholar
  126. 126.
    Dickman CA, Zabramski JM, Hadley MN, Rekate HL, Sonntag VK. Pediatric spinal cord injury without radiographic abnormalities: report of 26 cases and review of the literature. J Spinal Disord. 1991;4:296–305.PubMedCrossRefGoogle Scholar
  127. 127.
    Mahajan P, Jaffe DM, Olsen CS, Leonard JR, Nigrovic LE, Rogers AJ, et al. Spinal cord injury without radiologic abnormality in children imaged with magnetic resonance imaging. J Trauma Acute Care Surg. 2013;75(5):843–7.PubMedCrossRefGoogle Scholar
  128. 128.
    Hwang M, Zebracki K, Chlan KM, Vogel LC. Longitudinal changes in medical complications in adults with pediatric-onset spinal cord injury. J Spinal Cord Med. 2014;37(2):171–8.PubMedPubMedCentralCrossRefGoogle Scholar
  129. 129.
    Zidek K, Srinivasan R. Rehabilitation of a child with a spinal cord injury. Semin Pediatr Neurol. 2003;10:140–50.PubMedCrossRefGoogle Scholar
  130. 130.
    Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405–11.PubMedCrossRefGoogle Scholar
  131. 131.
    Bracken MB, Shepard MJ, Collins WF Jr, Holford TR, Baskin DS, Eisenberg HM, et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. J Neurosurg. 1992;76(1):23–31.PubMedCrossRefGoogle Scholar
  132. 132.
    Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up. Results of the third National Acute Spinal Cord Injury randomized controlled trial. J Neurosurg. 1998;89(5):699–706.PubMedCrossRefGoogle Scholar
  133. 133.
    Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the third National Acute Spinal Cord Injury randomized controlled trial. JAMA. 1997;277(20):1597–604.PubMedCrossRefGoogle Scholar
  134. 134.
    Pettiford JN, Bikhchandani J, Ostlie DJ, St Peter SD, Sharp RJ, Juang D. A review: the role of high dose methylprednisolone in spinal cord trauma in children. Pediatr Surg Int. 2012;28:287–94.PubMedCrossRefGoogle Scholar
  135. 135.
    Fehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the surgical timing in acute spinal cord injury study (STASCIS). PLoS One. 2012;7(2):e32037.PubMedPubMedCentralCrossRefGoogle Scholar
  136. 136.
    Li YL, Hedequist D. Traumatic pediatric spine injuries. In: Rau RD, editor. Orthopaedic knowledge update: spine. 4th ed. Rosemont: Americal Academy of Orthopaedic Surgeons; 2012. p. 467.Google Scholar

Copyright information

© Springer Science+Business Media LLC 2018

Authors and Affiliations

  1. 1.Orthopedic Surgery and PediatricsDrexel University College of Medicine, St. Christopher’s Hospital for ChildrenPhiladelphiaUSA
  2. 2.St. Christopher’s Hospital for Children, Orthopedic Center for ChildrenPhiladelphiaUSA
  3. 3.Division of Pediatric Orthopedic Surgery, Orthopedic Surgery ResidencyAlpert Medical School of Brown UniversityProvidenceUSA
  4. 4.Department of Orthopedic Surgery, Children’s Mercy Hospital and Clinics – Kansas CityUniversity of Kansas School of MedicineKansas CityUSA

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