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[Pediatric Upper Cervical Spine Injuries: a Systematic Review]
Lucie Salavcová1,2, Jan Štulík1, Ondřej Naňka2
1Klinika spondylochirurgie 1. lekarske fakulty Univerzity Karlovy a Fakultni nemocnice v Motole, Praha.
Insights
Pediatric upper cervical spine injuries are rare and diverse, with girls slightly more affected. Traffic accidents are the main cause, and while most survivors are neurologically intact, instrumentation failure is a common complication.
Area of Science:
- Orthopedics
- Pediatric Traumatology
- Neurosurgery
Background:
- Upper cervical spine injuries in children are uncommon and present a heterogeneous clinical picture.
- Existing literature often lacks consistency in defining pediatric age ranges and the specific boundaries of the upper cervical spine.
- This heterogeneity complicates the comparison of findings across different studies.
Purpose of the Study:
- To systematically review the literature on pediatric upper cervical spine injuries.
- To analyze patient demographics, injury epidemiology, classification systems, diagnostic and treatment modalities, neurological outcomes, associated injuries, and complications.
Main Methods:
- A systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.
- Searched the MEDLINE database for studies on pediatric upper cervical spine injuries published between 1991 and 2022.
- Included 15 studies after rigorous screening of 1354 initially identified articles.
Main Results:
- The study cohort included a slight female predominance (51.1%).
- Radiography (X-ray) and computed tomography (CT) were the primary diagnostic tools, while magnetic resonance imaging (MRI) was less utilized.
- Surgical intervention was employed in over a quarter of cases (27.6%), with instrumentation failure noted as the most frequent complication (11.3%).
- Craniocerebral trauma was the most common concomitant injury (39%).
Conclusions:
- Pediatric upper cervical spine injuries are rare, diverse, and inconsistently documented in the literature.
- Traffic accidents are a leading cause, with a mean patient age of 6.7 years.
- While most survivors achieve neurological integrity, complications such as instrumentation failure and associated craniocerebral trauma require attention.
Purpose Of The Study:
The study aimed to systematically review the available literature focusing on upper cervical spine injuries in children, namely the age and sex of patients, epidemiology of injuries, classifications used, diagnosis and treatment methods, neurologic deficit, concomitant injuries, and potential complications.
Material And Methods:
The systematic review was elaborated in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The studies assessing pediatric upper cervical spine injuries were searched for in the MEDLINE database in September 2023. The studies included were published between 1991 and 2022.
Results:
A total of 1354 studies were found through the database search. Subsequently, 53 articles were excluded as duplicates and 1217 due to irrelevant title or abstract. The full text of 84 studies was reviewed. Sixty-nine manuscripts failed to meet the predefined criteria. In the end, the systematic review was based on 15 studies. In the cohort of paediatric patients with upper cervical spine injuries, the girls accounted for 51.1% and boys for 48.9%. X-ray (64.9%) and CT (56.2%) were the most commonly used imaging for diagnosis, with MRI (51.5%) being the least used diagnostic method. Surgical procedure was opted for in treating more than a quarter of cases (27.6%). Most of the surviving patients were neurologically intact (69.2%), a fairly large number of patients (14.4%) died. The most common concomitant injury was craniocerebral trauma (39%) and the most common treatment complication was the instrumentation failure (11.3%).
Discussion:
Upper cervical spine injuries are rare in children and represent a relatively heterogeneous group. The literature on this topic is mostly inconsistent. Currently, there is just a few studies dealing with pediatric upper cervical spine injuries as a whole; more often the papers focus on a single type of injury. Inconsistencies also occur in defining the age limit for the pediatric spine and in defining the upper cervical spine. For these reasons, comparing the results of individual studies can be difficult.
Conclusions:
The mean age of pediatric patients with upper cervical spine injuries was 6.7 years, with a slight predominance of girls. The most common cause of injury was traffic accidents. X-ray and CT were the most commonly used diagnostic methods and surgical therapy was opted for in treating more than a quarter of cases. More than two-thirds of the surviving patients were neurologically intact. Instrumentation failure was the most common treatment complication and craniocerebral trauma was the most common concomitant injury.
