Spinal Trauma

  • Paolo Tortori-Donati
  • Andrea Rossi
  • Milena Calderone
  • Carla Carollo


The developing spine is an osteo-cartilaginous complex in which the cartilaginous component is prevalent, especially in the first years of life. This confers to the spine a wide degree of motility and deformability and allows efficient absorption of traumatic vectors. As a consequence, vertebral fractures are rare events in the pediatric age group. Overall, pediatric traumas account for only 5%–10% of all spinal traumas in the general population. There are two incidence peaks, i.e., one under 5 years of age with lesions affecting mostly the upper cervical spine, and one after 10 years of age [1] with involvement of the lower cervical and thoracolumbar spine.


Spinal Cord Injury Cervical Spine Vertebral Body Spinal Cord Lesion Burst Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Hamilton MG, Myles ST. Pediatric spinal injury: review of 174 hospital admission. J Neurosurg 1992; 77:700–704, 1992.CrossRefPubMedGoogle Scholar
  2. 2.
    Magnan P, Evans DC, Vezina JL. Interactive spine trauma tutorial, 2004. Available online at Scholar
  3. 3.
    Boyd R, Massey R, Duane L, Yates DW. Whiplash associated disorder in children attending the emergency department. Emerg Med J 2002; 19:311–315.CrossRefPubMedGoogle Scholar
  4. 4.
    Marshall KW, Koch BL, Egelhoff JC. Air bag-related deaths and serious injuries in children: injury patterns and imaging findings. AJNR Am J Neuroradiol 1998; 19:1599–1607.PubMedGoogle Scholar
  5. 5.
    Roche C, Carty H. Spinal trauma in children. Pediatr Radiol 2001; 31:677–700.CrossRefPubMedGoogle Scholar
  6. 6.
    Ogden JA. Skeletal Injury in the Child. New York: Springer Verlag, 2000.Google Scholar
  7. 7.
    Allen B, Ferguson R. Cervical spine trauma in children. In: Bradford D, Hensinger R (eds) The Pediatric Spine. New York: Thieme, 1985.Google Scholar
  8. 8.
    Roy-Camille R, Saillant G, Lapresle P, Leonard P. [Recent fractures of the odontoid. Prognostic factors]. Presse Med 1983; 12:2233–2236.PubMedGoogle Scholar
  9. 9.
    Reynolds R. Pediatric spinal injury. Curr Opin Pediatr 2000; 12:67–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Menezes A, Godersky J, Smoker W. Spinal cord injury. In: McLaurin R, Schut L, Venes J et al (eds) Pediatric Neurosurgery, 2nd edn. Philadelphia: Saunders, 1989.Google Scholar
  11. 11.
    Felsberg GJ, Tien RD, Osumi AK, Cardenas CA. Utility of MR imaging in pediatric spinal cord injury. Pediatr Radiol 1995; 25:131–135.CrossRefPubMedGoogle Scholar
  12. 12.
    Keiper MD, Zimmerman RA, Bilaniuk LT. MRI in assessment of the supportive soft tissues of the cervical spine in acute trauma in children. Neuroradiology 1998; 40:359–363.CrossRefPubMedGoogle Scholar
  13. 13.
    [No authors listed]. Management of pediatric cervical spine and spinal cord injury. Neurosurgery 2002; 50(3 suppl):S85–S99.Google Scholar
  14. 14.
    Deliganis AV, Baxter AB, Hanson JA, Fisher DJ, Cohen WA, Wilson AJ, Mann FA. Radiologic spectrum of craniocervical distraction injuries. Radiographics 2000; 20 (Spec No):S237–S250.PubMedGoogle Scholar
  15. 15.
    Angel CA, Ehlers RA. Images in clinical medicine. Atloidooccipital dislocation in a small child after air-bag deployment. N Engl J Med 2001; 345:1256.CrossRefPubMedGoogle Scholar
  16. 16.
    Bailey H, Perez N, Blank-Reid C, Kaplan LJ. Atlanto-occipital dislocation: an unusual lethal airbag injury. J Emerg Med 2000; 18:215–219.CrossRefPubMedGoogle Scholar
  17. 17.
    Shkrum MJ, McClafferty KJ, Nowak ES, German A. Driver and front seat passenger fatalities associated with air bag deployment. Part 1: A Canadian study. J Forensic Sci 2002; 47:1028–1034.PubMedGoogle Scholar
  18. 18.
    Houle P, McDonnell DE, Vender J. Traumatic atlanto-occipital dislocation in children. Pediatr Neurosurg 2001; 34:193–197.CrossRefPubMedGoogle Scholar
  19. 19.
    Labbe JL, Leclair O, Duparc B. Traumatic atlanto-occipital dislocation with survival in children. J Pediatr Orthop B 2001; 10:319–327.CrossRefPubMedGoogle Scholar
  20. 20.
    Sun PP, Poffenbarger GJ, Durham S, Zimmerman RA. Spectrum of occipitoatlantoaxial injury in joung children. J Neurosurg Spine 2000; 93:28–39.CrossRefGoogle Scholar
  21. 21.
    Werne S. Studies in spontaneous atlas dislocation. Acta Orthop Scand Suppl 1957; 23:12–83.Google Scholar
  22. 22.
    Bulas DI, Fitz CR, Johnson DL. Traumatic atlanto-occipital dislocation in children. Radiology 1993; 188:155–158.PubMedGoogle Scholar
  23. 23.
    Costello MW. Images in emergency medicine. Traumatic atlanto-occipital dislocation. Ann Emerg Med 2004; 44:277, 285.CrossRefPubMedGoogle Scholar
  24. 24.
    Bani A, Gilsbach JM. Atlantooccipital distraction: a diagnostic and therapeutic dilemma: report of two cases. Spine 2003; 28:E95–E97.CrossRefPubMedGoogle Scholar
  25. 25.
    Judd DB, Liem LK, Petermann G. Pediatric atlas fracture: a case of fracture through a synchondrosis and review of the literature. Neurosurgery 2000; 46:991–994.CrossRefPubMedGoogle Scholar
  26. 26.
    Suss RA, Zimmerman RD, Leeds NE. Pseudospread of the atlas: false sign of Jefferson fracture in young children. AJR Am J Roentgenol 1983; 140:1079–1082.PubMedGoogle Scholar
  27. 27.
    Mazur JM, Loveless EA, Cummings RJ. Combined odontoid and jefferson fracture in a child: a case report. Spine 2002; 27:E197–E199.CrossRefPubMedGoogle Scholar
  28. 28.
    Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974; 56:1663–1674.PubMedGoogle Scholar
  29. 29.
    Connolly B, Emery D, Armstrong D. The odontoid synchondrotic slip: an injury unique to young children. Pediatr Radiol 1995; 25(Suppl 1):S129–S133.PubMedGoogle Scholar
  30. 30.
    Kleinman PK, Shelton YA. Hangman’s fracture in an abused infant: imaging features. Pediatr Radiol 1997; 27:776–777.CrossRefPubMedGoogle Scholar
  31. 31.
    Ranjith RK, Mullett JH, Burke TE. Hangman’s fracture caused by suspected child abuse. A case report. J Pediatr Orthop B 2002; 11:329–332.CrossRefPubMedGoogle Scholar
  32. 32.
    Swischuk LE. Anterior displacement of C2 in children: physiologic or pathologic. Radiology 1977; 122:759–763.PubMedGoogle Scholar
  33. 33.
    Floman Y, Kaplan L, Elidan J, Umansky F. Transverse ligament rupture and atlanto-axial subluxation in children. J Bone Joint Surg Br 1991; 73:640–643.PubMedGoogle Scholar
  34. 34.
    Muniz AE, Belfer RA. Atlantoaxial rotary subluxation in children. Pediatr Emerg Care 1999; 15:25–29.PubMedCrossRefGoogle Scholar
  35. 35.
    Kim KS, Chen HH, Russell EJ, Rogers LF. Flexion teardrop fracture of the cervical spine: radiographic characteristics. AJR Am J Roentgenol 1989; 152:319–326.PubMedGoogle Scholar
  36. 36.
    Orenstein JB, Klein BL, Ochsenschlager DW. Delayed diagnosis of pediatric cervical spine injury. Pediatrics 1992; 89:1185–1188.PubMedGoogle Scholar
  37. 37.
    Baker C, Kadish H, Schunk JE. Evaluation of pediatric cervical spine injuries. Am J Emerg Med. 1999; 17:230–234.CrossRefPubMedGoogle Scholar
  38. 38.
    Reddy SP, Junewick JJ, Backstrom JW. Distribution of spinal fractures in children: does age, mechanism of injury, or gender play a significant role? Pediatr Radiol 2003; 33:776–781.CrossRefPubMedGoogle Scholar
  39. 39.
    Walsh A, Sheehan E, Walsh MG. Lumbar Chance fracture associated with use of the lap belt restraint in an adolescent. Ir Med J 2003; 96:148–149.PubMedGoogle Scholar
  40. 40.
    Willen J, Lindahl S, Irstam L, Aldman B, Nordwall A. The thoracolumbar crush fracture. An experimental study on instant axial dynamic loading: the resulting fracture type and its stability. Spine 1984; 9:624–631.CrossRefPubMedGoogle Scholar
  41. 41.
    Ghatan S, Ellenbogen RG. Pediatric spine and spinal cord injury after inflicted trauma. Neurosurg Clin N Am 2002; 13:227–233.CrossRefPubMedGoogle Scholar
  42. 42.
    Gabos PG, Tuten HR, Leet A, Stanton RP. Fracture-dislocation of the lumbar spine in an abused child. Pediatrics 1998; 101:473–477.CrossRefPubMedGoogle Scholar
  43. 43.
    Levin TL, Berdon WE, Cassell I, Blitman NM. Thoracolumbar fracture with listhesis—an uncommon manifestation of child abuse. Pediatr Radiol 2003; 33:305–310.PubMedGoogle Scholar
  44. 44.
    Soto-Ares G, Denes M, Noule N, Vinchon M, Pruvo JP, Gosset D. [Subdural hematomas in children: role of cerebral and spinal MRI in the diagnosis of child abuse]. J Radiol 2003; 84:1757–1765.PubMedGoogle Scholar
  45. 45.
    Brown RL, Brunn MA, Garcia VF. Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 2001; 36:1107–1114.CrossRefPubMedGoogle Scholar
  46. 46.
    Martin BW, Dykes E, Lecky FE. Patterns and risks in spinal trauma. Arch Dis Child 2004; 89:860–865.CrossRefPubMedGoogle Scholar
  47. 47.
    Pang D, Wilberger JE. Spinal cord injury without radiographic abnormalities in children. J Neurosurg 1982; 57:114–129.CrossRefPubMedGoogle Scholar
  48. 48.
    Kriss VM, Kriss TC. SCIWORA (spinal cord injury without radiographic abnormality) in infants and children. Clin Pediatr (Phila) 1996; 35:119–124.CrossRefGoogle Scholar
  49. 49.
    Barnes PD. Acquired abnormalities of the spine and spinal neuraxis. In: Wolpert SM, Barnes PD (eds) MRI in Pediatric Neuroimaging. St. Louis: Mosby year Book, 1992.Google Scholar
  50. 50.
    Grabb PA, Pang D. Magnetic resonance imaging in the evaluation of spinal cord injury without radiographic abnormality in children. Neurosurgery 1994; 35:406–414CrossRefPubMedGoogle Scholar
  51. 51.
    Davis PC, Reisner A, Hudgins PA, Davis WE, O’Brien MS. Spinal injuries in children: role of MR. AJNR Am J Neuroradiol 1993; 14:607–617.PubMedGoogle Scholar
  52. 52.
    Proctor MR. Spinal cord injury. Crit Care Med 2002; 30(11 suppl):S489–S99.CrossRefPubMedGoogle Scholar
  53. 53.
    Menticoglou SM, Perlman M, Manning FA. High cervical spinal cord injury in neonates delivered with forceps: report of 15 cases. Obstet Gynecol 1995; 86:589–594.PubMedGoogle Scholar
  54. 54.
    Piatt JH Jr. Birth injuries of the brachial plexus. Pediatr Clin North Am 2004; 51:421–440.CrossRefPubMedGoogle Scholar
  55. 55.
    Marchetti PG, Bartolozzi P, Binazzi R, Vaccari V, Girolami M, Impallomeni C, Morici F, Bevoni R. Preoperative reduction of spondylolisthesis. Chir Organi Mov 2002; 87:203–215.PubMedGoogle Scholar
  56. 56.
    Lim MR, Yoon SC, Green DW. Symptomatic spondylolysis: diagnosis and treatment. Curr Opin Pediatr 2004; 16:37–46.CrossRefPubMedGoogle Scholar
  57. 57.
    Waicus KM, Smith BW. Back injuries in the pediatric athlete. Curr Sports Med Rep 2002; 1:52–58.PubMedGoogle Scholar
  58. 58.
    Major NM, Helms CA, Richardson WJ. MR imaging of fibrocartilaginous masses arising on the margins of spondylolysis defects. AJR Am J Roentgenol 1999; 173:673–676.PubMedGoogle Scholar
  59. 59.
    Martinez-Lage JF, Fernandez Cornejo V, Lopez F, Poza M. Lumbar disc herniation in early childhood: case report and literature review. Childs Nerv Syst 2003; 19:258–260.PubMedGoogle Scholar
  60. 60.
    Callahan DJ, Pack LL, Bream RC, Hensinger RN. Intervertebral disc impingement syndrome in a child. Report of a case and suggested pathology. Spine 1986; 11:402–404.CrossRefPubMedGoogle Scholar
  61. 61.
    Gerlach R, Zimmermann M, Kellermann S, Lietz R, Raabe A, Seifert V. Intervertebral disc calcification in childhood—a case report and review of the literature. Acta Neurochir (Wien) 2001; 143:89–93.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • Paolo Tortori-Donati
    • 1
  • Andrea Rossi
    • 1
  • Milena Calderone
    • 2
  • Carla Carollo
    • 2
  1. 1.Department of Pediatric NeuroradiologyG. Gaslini Children’s Research HospitalGenoaItaly
  2. 2.Department of NeuroradiologyCivic HospitalPaduaItaly

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