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Cervical spine injuries in children, part II: management and special considerations

Joshua S Easter1, Roger Barkin, Carlo L Rosen

  • 1Department of Emergency Medicine, Children's Hospital of Boston, Boston, Massachusetts, USA.

The Journal of Emergency Medicine
|May 25, 2010
PubMed

Insights

Pediatric cervical spine injuries require careful evaluation due to normal anatomical variations. Magnetic resonance imaging (MRI) is crucial for diagnosing spinal cord injuries in children when initial imaging is inconclusive.

Area of Science:

  • Pediatric Emergency Medicine
  • Radiology
  • Orthopedic Surgery

Background:

  • Cervical spine injury diagnosis and management in children presents unique challenges compared to adults.
  • Understanding pediatric cervical spine anatomy is critical for accurate assessment.

Purpose of the Study:

  • To outline the role of magnetic resonance imaging (MRI) in diagnosing pediatric cervical spine injuries.
  • To discuss the emergency department management of pediatric cervical spine injuries.

Main Methods:

  • Review of common pediatric cervical spine anatomical variations (e.g., pseudosubluxation, atlantodens interval widening).
  • Discussion of imaging modalities, emphasizing MRI for suspected spinal cord injury.
  • Clinical presentation assessment including mechanism of injury and physical findings.

Main Results:

  • Normal anatomical variants in children can mimic injury on imaging.
  • Atlantorotary subluxation and spinal cord injury without radiographic abnormality are significant concerns.
  • MRI is effective in detecting spinal cord injuries not visible on X-ray or CT.

Conclusions:

  • Knowledge of normal pediatric cervical spine variations aids in accurate injury identification.
  • Emergency physicians should consider MRI for children with neurological deficits and normal initial imaging.
  • Prompt diagnosis and management are essential to prevent morbidity from pediatric cervical spine injuries.
Abstract

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