1. CERVICAL SPINE INJURY: PEDIATRICS LEONARD E. SWISCHUK, M.D. THE UNIVERSITY OF TEXAS MEDICAL BRANCH GALVESTON, TX

2. CHILDHOOD INJURIES LESS COMMON THAN IN ADULTS

3. MORE INJURIES OCCUR IN THE UPPER CERVICAL SPINE IN INFANTS AND YOUNG CHILDREN

4. WHY ?

5. APEX OF THE FLEXION CURVE IN UPPER SPINE

7. DIVIDE PATIENTS BY AGE GROUP –0 to 5 –6 to 10 –11 and over

8. PREVERTEBRAL SOFT TISSUES ─Buckling and pseudothickening ─Full inspiration-extension ─Pharyngeal-tracheal stepoff ─Don’t spend too much time

11. OTHER PROBLEMS –Infant and children are hypermobile –Physiologic motion may be pronounced –Immature spine –Synchondroses, etc.

12. DENS FRACTURES –Occur through dens body synchondrosis in infants –In infants, not the same as in adults –Fragmented os terminale, pseudo fracture –Os odontoideum pseudo fracture

13. DENS FX ANTERIOR

14. OS TERMINALE

18. FRAGMENTED OS TERMIONALE NORMAL

19. FRAGMENTED OS TERMINALE NORMAL

21. PSEUDO FX OS ODNTOIDEUM

22. HANGMAN FRACTURES –These occur in infants –Heavy head is the mechanism –Differentiate from congenital defects

25. CONGENITAL DEFECT

28. C2 SYNCHONDROSES (PSEDUOFRACTURES) ─Dens-body ─Dens-neural arch ─Oblique view ─CT-parasagittal view ─Aberrant synchondroses

35. FLEXION – ROTATION INJURIES –Same as in adults –Usually mid cervical spine –Usually older children

36. FX WEDGING ANT HYPERFLEX

37. NORMAL ANTERIOR WEDGING –C3, C4

38. WEDGING NORMAL C3 C4

39. WEDGING NORMAL C3

44. ANTERIOR SUBLUXATION (Physiologic) –C2-C3 (mostly) –C3-C4

47. ANT SUBLUX C2-C3 PHYSIOLOGIC

50. HYPEREXTENSION INJURIES –Same and in adults –Not as common as in adults

51. WIDE DISC HYPEREXTENSIONAND FX

52. FX POSTERIOR ARCH C1

53. CONGENITAL DEFECT POST ARCH C1

55. DISLOCATION C1 – C2 –Relatively uncommon overall –Requires severe injury –Can be seen in infants –May disrupt blood supply to os terminale

56. DISLOCATION C1-C2

57. PREDENTAL DISTANCE –Maybe very prominent in normal infants and children –Up to 5 mm –2 mm flexion extension movement is normal

58. PREDENTAL DISTANCE 5 MM EXTENSION NORMAL

59. SAME PATIENT FLEXION 5MM NORMAL

62. RULE OF 2 ─ 2 mm or less ─ Any movement ─ Usually normal

63. INTERSPINOUS DISTANCE C1, C2 –Maybe very generous in infants and young children –May open 10 to 12 mm and still be normal –Look for anterior displacement of the anterior arch of C1 with true injury

64. ABNORMAL C1-C2 DISLOCATION

65. NORMAL NO DISLOCATION

66. AXIAL LOAD INJURIES –Same as in adults –Usually older children

67. JEFFERSON FRACTURES –Very rare in infants –Differentiate from synchondroses

68. JEFFERSON FX

69. JEFFERSON FRACTURE

70. SYNCHONDROSES NORMAL

71. NORMAL - PSEUDO OFF SET - UP TO 2 YTS

72. INFANTS AND CHILDREN ARE HYPERMOBILE

73. TORTE COLLIS

74. SUGGESTED READING –Platzer P, Manuela J, Thalhammer G, et al: J Trauma 62:389-396, Feb. 2007. –Apple JS, Kirks DR, Merten DF, et al: Pediatr Radiol 17:45-49, 1987. –Hadley MN, Babramski JM, Browner CM, et al: J Neurosurg 68:18-24, 1988. –“Imaging of the Cervical Spine in Children” Swischuk, LE, 2002 Springer-Verlag, New York, pgs. 75-121.

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