Radiology of the Pediatric Cervical Spine:
http://www.wheelessonline.com/ortho/pediatric_c_spine
- See:
- development of atlas
- development of axis
- Discussion:
- most pediatric C-spine injuries will occur
above C3, and therefore lateral radiographs should be
centered on C-3;
- Atlantoaxial Rotatory Fixation:
- SCIWORA: Syndrome of Spinal Cord Injury w/o
Radiographic Abnormality;
- accounts for up to 2/3 of severe
cervical injuries in children < 8 years of age;
- inherent elasticity in pediatric
cervical spine can allow severe spinal cord injury to
occur in absence of x-ray findings;
- fracture through the cartilaginous end
plates (which are not visualized by x-rays), may be
among the causes of this injury;
- radiographs:
- diagnosis of exclusion:
- MRI may give a more anatomic
diagnosis by showing hemorrhage or edema of the
spinal cord;
- pseudosubluxation: anterior
displacement may be up to 4 mm;
- treatment: spine is immobilized for one
to three weeks;
- Radiographs:
- lateral radiograph in children < 10 yrs of age:
- atlantooccipital disassociation
- atlas dens interval < 3.5 mm
- cervical stenosis:
- retropharyngeal space: (will increase w/
crying)
- C3: < 6-8 mm;
- C6: < 14 mm;
- odontoid frxs: accounts for majority of
pediatric C-spine frx (upto 75%)
- development & anomalies of axis: (os
odontoideum):
- pseudosubluxation C2-3: 0-3 mm
- note that pediatric trauma
patients should be placed on a trauma board which
allows the head to slightly hyperextend;
- when placed on a standard truama
board, the child's neck will flex (due to the large
pediatric head size), which accentuates
pseudosubluxation;
- canal width: 14 mm;
- spinous process widening:
- C1-C2 interspinous space should
not be greater than 10 mm;
- widening is present when the
distance is more than 1.5 times the inter-spinous
distance of adjacent spinal segments;
- odontoid view:
- combined lateral overhang of more than 7
mm of (C1-C2 facets) indicates an unstable
Jefferson's Fracture;
- oblique view:
- oblique radiographs are not essential in
the pediatric population, since facet injuries are
uncommon;
The surgical treatment of instability of the upper
part of the cervical spine in children and
adolescents.
Fusion of the upper cervical spine in children and
adolescents. An analysis of 17 patients.
The anterior cervical approach for traumatic injuries
to the cervical spine in children.
Cervical disc calcification in children: A long term
review. CC Wong. et al. Spine. Vol 17. 1992. p 139144.
Acute fractures and dislocations of the cervical
spine in children and adolescents.
Emergency transport and positioning of young children
who have an injury of the cervical spine. The
standard backboard may be hazardous.
Intervertebral disc calcification syndromes in
children. DH Sonnabend et al. JBJS Vol 64-B 1982. p
25-31.
Congenital anomalies of the cervical spine. [Review]
Familial cervical dysplasia.
Pediatric spinal injury: In the very young.
Simson GP, McLone DG, et al:
J Neurosurg
1988;68:25-30.
Ruge JR,
Pediatric spinal trauma. Hadley MN, Zabramski JM,
Browner CM, et al: J Neurosurg 1988;68:18-24.
Cervical spine injuries in childhood. DL Evans and D
Bethem. J. Pediatric Orthopaedics. Vol 9. 1989. p
563-568.
Cervical Spine Fracture-Dislocation Birth Injury:
Prevention, Recognition, and Implications for the
Orthopaedic Surgeon.
Cervical spine injuries in pediatric patients.