Abstract
Objective
Traumatic lesions of upper cervical spine are rare in children. To evaluate their experience with this lesions and factors affecting outcome, authors conducted a retrospective study of 28 cases of upper pediatric cervical spine injuries treated in the last 25 years.
Materials and methods
To help in treatment of these lesions, we studied our series and reviewed the literature. Patients were divided into three groups: 0 to 2, 3 to 8, and 9 to 16 years, and managed according to status at presentation and type of injury.
Results
Seven patients were managed surgically and 21 nonsurgically (3 halo braces, 18 hard collars or molded braces). Patients in the younger age group sustained more neurological injuries than the others. In group 1, 33% present a fracture/luxation of C0/C1 or odontoid. In group 2, 80% had sustained fracture/luxations of C2. In group 3, 60% present odontoid fractures. At late follow-up review, solid fusions were demonstrated in all patients. Neurological deterioration occur in six patients. The mortality rate was 12%. Compared with other authors’ report, incidence of this lesions increased but not the number of those managed surgically.
Conclusions
Management must be tailored to the patient’s age, neurological status, type, and level of injury. Compared with other author’s experience, fusion and instrumentation procedures were used less frequently. Signs of medullary compression, significant spine deformation, dynamic instability, and age higher than 8 years are the criteria for surgery. The criteria for instability in children are different from those used in adults because the residual spinal growth is a major concern. The best treatment is therefore preventive.
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References
Anderson JM, Schutt AH (1980) Spinal injury in children: a review of 156 cases seen from 1950 through 1978. Mayo Clin Proc 55:499–504
Apple JS, Kirks DR, Merten DF (1987) Cervical spine fractures and dislocations in children. Pediatr Radiol 17:45–49
Birney TJ, Hanley EN (1989) Traumatic cervical spine injuries in childhood and adolescence. Spine 14:1277–1282
Bohn D, Armstrong D, Becker L (1990) Cervical spine injuries in children. J Trauma 30:463–469
Dickman CA, Zabramski JM, Hadley MN (1991) Pediatric spinal cord injury without radiographic abnormalities: report of 26 cases and review of the literature. J Spinal Disord 4:296–305
Farley FA, Hensinger RN, Herzenberg JE (1992) Cervical spinal cord injury in children. J Spinal Disord 5:410–416
Fesmire FM, Luten RC (1989) The pediatric cervical spine: developmental anatomy and clinical aspects. J Emerg Med 7:133–142
Givens TG, Polley KA, Smith GF (1996) Pediatric cervical spine injury: a three-year experience. J Trauma 41:310–314
Grabb PA, Pang D (1994) Magnetic resonance imaging in the evaluation of spinal cord injury without radiographic abnormality in children. Neurosurgery 35:406–414
Hadley MN, Zabramski JM, Browner CM (1988) Pediatric spinal trauma. Review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 68:18–24
Hamilton MG, Myles ST (1992) Pediatric spinal injury: review of 61 deaths. J Neurosurg 77:705–708
Henrys P, Lyne ED, Lifton C (1977) Clinical review of cervical spine injuries in children. Clin Orthop 129:172–176
Hill SA, Miller CA, Kosnik EJ (1984) Pediatric neck injuries. A clinical study. J Neurosurg 60:700–706
Kalfas I, Wilberger J, Goldberg A (1998) Magnetic resonance imaging in acute spinal cord trauma. Neurosurgery 23:295–299
Kewalramani LS, Kraus JF, Sterling HM (1980) Acute spinal-cord lesions in a pediatric population: Epidemiological and clinical features. Paraplegia 18:206–219
Lowry DW, Pollack IF, Clyde B (1997) Upper cervical spine fusion in the pediatric population. J Neurosurg 87:671–676
Manary MJ, Jaffe DM (1996) Cervical spine injuries in children. Pediatr Ann 25:423–428
Michael DB, Guyot DR, Darmody WR (1989) Coincidence of head and cervical spine injury. J Neurotrauma 6:177–189
Mirvis SE, Diaconis JN, Chirico PA (1989) Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study. Radiology 170:831–834
Nitecki S, Moir CR (1994) Predictive factors of the outcome of traumatic cervical spine fracture in children. J Pediatr Surg 29:1409–1411
Orenstein JB, Klein BL, Gotschall CS (1994) Age and outcome in pediatric cervical spine injury: 11-year experience. Pediatr Emerg Care 10:132–137
Osenbach RK, Menezes AH (1992) Pediatric spinal cord and vertebral column injury. Neurosurgery 30:385–390
Pang D, Wilberger JE (1982) Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57:114–129
Rauzzino MJ, Hadley MN (1996) Pediatric spinal cord injuries. In: Menezes AH, Sonntag VKH (eds) Principles of spinal surgery. McGraw-Hill, New York, pp 817–840
Roy L, Gibson DA (1970) Cervical spine fusions in children. Clin Orthop 73:146–151
Ruge JR, Sinson GP, McLone DG (1988) Pediatric spinal injury: the very young. J Neurosurg 68:25–30
Saleh J, Raycroft JF (1992) Hyperflexion injury of cervical spine and central cord syndrome in a child. Spine 17:234–237
Shacked I, Ram Z, Hadani M (1993) The anterior cervical approach for traumatic injuries to the cervical spine in children. Clin Orthop 292:144–150
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Duhem, R., Tonnelle, V., Vinchon, M. et al. Unstable upper pediatric cervical spine injuries: report of 28 cases and review of the literature. Childs Nerv Syst 24, 343–348 (2008). https://doi.org/10.1007/s00381-007-0497-0
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DOI: https://doi.org/10.1007/s00381-007-0497-0