3/15/2023 0 Comments Spine align table williams![]() ![]() Physical examination should include vital signs, examination of the neck and neurologic examination. **Any child with symptoms suggestive of cervical spinal injury should be immediately immobilized and sent for radiographic evaluation**. Some patients may present without any symptoms but this does not exclude spinal injury. Neurologic symptoms may also be present such as burning, weakness, and dysthesias. The classic triad of symptoms of cervical spine injury is localized neck tenderness, muscle spasm and decreased range of motion of the neck. The history must include the presence of symptoms even if they have already resolved at the time of evaluation. Hyperflexion injuries are most common and are associated with wedge fractures of the anterior cervical bodies with disruption of posterior aspects. ![]() The mechanism on injury may also predict the type of injury to expect. The major causes of cervical spine injury include trauma associated with severe force, diving, acceleration-deceleration injury and severe multisystem trauma. This includes children with Down Syndrome (atlano-axial instability), Klippel-Feil syndrome (congenital fusion of cervical spine), previous cervical spine surgery, and other syndromes affecting the cervical spine. ![]() Some children are predisposed to cervical injuries more than others and this should be taken into consideration when taking a history. A spinal cord injury should be suspected if the child has a history of numbness, tingling, or brief paralysis. Elements of the history that are critical include the cause of trauma, the mechanism of injury and the presence of any symptoms at the time of injury. History:Īlthough it is not an easy task, thehistory can be very useful. Fractures traverse vertebral body growth plate.Īdapted from Tornetta and Einhorn (2004).Forces dissipated over several adjacent segments.Unique Anatomic Features of Children Age 8 and Younger Up to 30% of traumatic spine injuries in children present as a traumatic myelopathy known as spinal cord injury without radiographic abnormality (SCIWORA). Patients older than 8 years of age typically sustain more injuries below C4 and carry a much lower fatality rate. These factors increase the risk of injury to the levels of C1 and C2.Ĭervical spine injuries occur mainly in the upper cervical spine above C4 in patients 8 years of age or younger which most often involve the occiput, C1, and C2 complex and thus carries increased risk of fatality. Ligaments and joint capsules are more lax, facets are more horizontal, and the vertebral bodies are wedge shaped. Considering the large difference in ratio of head size to body the infant will experience different inertial forces compared to fully matured individuals. The unique anatomic features of children aged 8 years of age or younger are described in table 2. The pediatric cervical spine does not become adult like until about the age of 8 years. Normal Parameters of the Pediatric Cervical Spine Parameter In order to understand the critical aspects of cervical spine injury, it is important to acknowledge the normal parameters of the pediatric cervical spine described in table 1. ![]() Children 8 years of age or younger, tend to have more upper cervical injuries when compared with adults because of the anatomy of their bodies. Spinal trauma results from four main mechanisms consisting of hyperflexion, hyperextension, axial loading and lateral rotation. Clearance of the cervical spine is a method that is used to prevent the possibility of quadriplegia and complications of immobilization. It is essential that when one suspects cervical injury, appropriate evaluation and management must be undertaken. Injury to the cervical spine is rare in children and is most often seen in cases of blunt trauma. Excellent resources for the latest in chiropractic, low back pain, neck pain, migraine relief, wellness, prevention, and more.Click for pdf: Clearing the C-spine Introduction: ![]()
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