[Injuries of the cervical spine in children]

Area of Science:

• Pediatric Orthopedics
• Spinal Surgery
• Pediatric Traumatology

Background:

• Spinal injuries are uncommon in children, representing a small percentage of all fractures and spinal lesions.
• Younger children are more susceptible to upper cervical spine injuries, accounting for 50% of all cervical spine (C-spine) injuries in this age group.
• Key differences in pediatric versus adult spines diminish around age 10, after which diagnostic and treatment principles largely align with adult care.

Purpose of the Study:

• To highlight the unique aspects of pediatric spinal injuries, particularly in the cervical spine.
• To discuss diagnostic challenges, including differentiating normal developmental variations from true injuries.
• To present classification and treatment strategies for specific pediatric spinal lesions like atlantooccipital and atlantoaxial dislocations.

Main Methods:

• Review of pediatric spinal injury cases, focusing on upper cervical spine lesions.
• Analysis of diagnostic imaging to identify common misinterpretations.
• Evaluation of treatment outcomes for specific injuries, including conservative (halo-vest) and operative interventions (internal fixation).

Main Results:

• Atlantooccipital dislocations (AOD) are common in children, with a proposed classification based on dislocation direction.
• Injuries to the synchondrosis of the dens, often resulting from motor vehicle accidents, require specific management, with both conservative and surgical options yielding success.
• Atlantoaxial dislocations (AAD) include translatory and rotatory instabilities, managed with fusion or halo-fixation, with delayed reductions also possible.

Conclusions:

• Accurate interpretation of pediatric spine X-rays, considering normal development, is crucial for correct diagnosis.
• Specific pediatric spinal injuries like AOD and synchondrosis fractures require tailored diagnostic and treatment approaches.
• Both conservative and surgical interventions can be effective for pediatric cervical spine injuries, with treatment selection based on injury severity and stability.