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Paediatric cervical spine injuries - A descriptive analysis of thirty-two years of experience at a trauma centre
Maria Clara Correia1, Diogo Gonçalves Santos2, Miguel Relvas Silva2,3
1Orthopaedics and Traumatology Department, Unidade Local de Saúde São João, Porto, Portugal. maria.clara.correia@ulssjoao.min-saude.pt.
Insights
Pediatric cervical spine trauma is rare but serious, often involving associated injuries. Early MRI detection of spinal cord injury is crucial, and thorough evaluation is vital for improving outcomes in young patients.
Area of Science:
- Pediatric Traumatology
- Spinal Cord Injury Research
- Orthopedic Surgery
Background:
- Cervical spine (C-spine) trauma in children is infrequent but carries significant morbidity.
- Understanding injury patterns and outcomes is essential for effective management.
- A 32-year analysis provides valuable long-term insights into pediatric C-spine trauma.
Purpose of the Study:
- To describe and analyze pediatric cervical spine trauma over three decades.
- To identify demographic, injury, and treatment characteristics.
- To evaluate outcomes and mortality associated with pediatric C-spine injuries.
Main Methods:
- Retrospective observational study of pediatric patients (<16 years) with C-spine trauma (1991-2022).
- Data collection included demographics, injury mechanisms, affected levels, associated injuries, neurological deficits (Frankel scale), treatments, and outcomes.
- Patients were stratified into two age groups (<8 and 9-16 years) for comparative analysis.
Main Results:
- 102 pediatric patients identified; 65% were older than 8 years.
- Younger children (<8 years) more frequently sustained upper C-spine injuries (55.6%).
- Associated injuries occurred in 59% (mainly head trauma), and spinal cord injury without radiographic abnormality (SCIWORA) in 14.7% with 60% MRI-confirmed cord contusions.
- Neurological deficits were present in 38%, with 51.2% improving; mortality was 16.5%, higher with neurological impairment (p=0.004).
Conclusions:
- Pediatric C-spine trauma is uncommon, necessitating specialized evaluation.
- Magnetic Resonance Imaging (MRI) is critical for diagnosing spinal cord injuries in SCIWORA cases.
- Associated injuries significantly impact mortality, underscoring the need for comprehensive initial assessment and further multicenter research.
Purpose:
This study aims to describe and analyse pediatric cervical spine (C-spine) trauma over 32 years at a level 1 trauma centre.
Methods:
A retrospective observational study was conducted, including patients younger than 16 years hospitalised after C-spine trauma from 1991 to 2022. Data on demographics, injury mechanisms, affected levels, associated injuries, neurological deficits (Frankel scale), treatments, and outcomes were analysed. Patients were divided into two age groups: < eight years (Group A) and nine to 16 years (Group B). Injuries were categorised as SCIWORA or skeletal, and by level-upper (C0 to C2) or lower (C3 to C7). Statistical analysis was performed using SPSS v29.0 (p < 0.05).
Results:
A total of 102 patients were identified (67% male; 65% > 8 years). Younger children had more upper C-spine injuries (55.6%), lower injuries were more common in Group B (53%) (p = 0.006). mechanisms included motor vehicle accidents, pedestrian accidents, falls, and sports injuries. Associated injuries were present in 59% of cases, mainly head trauma. SCIWORA occurred in 14.7% of patients, with MRI-confirmed cord contusions in 60% of these. Most patients (74.7%) underwent conservative treatment. Neurological deficits were present in 38% of patients, and 51.2% showed improvement. The mortality rate was 16.5%, significantly higher among those with neurological impairment (p = 0.004).
Conclusion:
Pediatric C-spine trauma is uncommon. MRI is essential for detecting spinal cord injury in SCIWORA. The high prevalence and impact of associated injuries on mortality highlight the need for thorough primary evaluation. Multicenter studies are necessary to improve management strategies and outcomes.
