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CERVICAL SPINE INJURY: PEDIATRICS LEONARD E. SWISCHUK, M.D. THE UNIVERSITY OF TEXAS MEDICAL BRANCH GALVESTON, TX
CHILDHOOD INJURIES LESS COMMON THAN IN ADULTS
MORE INJURIES OCCUR IN THE UPPER CERVICAL SPINE IN INFANTS AND YOUNG CHILDREN
APEX OF THE FLEXION CURVE IN UPPER SPINE
DIVIDE PATIENTS BY AGE GROUP –0 to 5 –6 to 10 –11 and over
PREVERTEBRAL SOFT TISSUES ─Buckling and pseudothickening ─Full inspiration-extension ─Pharyngeal-tracheal stepoff ─Don’t spend too much time
OTHER PROBLEMS –Infant and children are hypermobile –Physiologic motion may be pronounced –Immature spine –Synchondroses, etc.
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
DENS FX ANTERIOR
FRAGMENTED OS TERMIONALE NORMAL
FRAGMENTED OS TERMINALE NORMAL
PSEUDO FX OS ODNTOIDEUM
HANGMAN FRACTURES –These occur in infants –Heavy head is the mechanism –Differentiate from congenital defects
C2 SYNCHONDROSES (PSEDUOFRACTURES) ─Dens-body ─Dens-neural arch ─Oblique view ─CT-parasagittal view ─Aberrant synchondroses
FLEXION – ROTATION INJURIES –Same as in adults –Usually mid cervical spine –Usually older children
FX WEDGING ANT HYPERFLEX
NORMAL ANTERIOR WEDGING –C3, C4
WEDGING NORMAL C3 C4
WEDGING NORMAL C3
ANTERIOR SUBLUXATION (Physiologic) –C2-C3 (mostly) –C3-C4
ANT SUBLUX C2-C3 PHYSIOLOGIC
HYPEREXTENSION INJURIES –Same and in adults –Not as common as in adults
WIDE DISC HYPEREXTENSIONAND FX
FX POSTERIOR ARCH C1
CONGENITAL DEFECT POST ARCH C1
DISLOCATION C1 – C2 –Relatively uncommon overall –Requires severe injury –Can be seen in infants –May disrupt blood supply to os terminale
PREDENTAL DISTANCE –Maybe very prominent in normal infants and children –Up to 5 mm –2 mm flexion extension movement is normal
PREDENTAL DISTANCE 5 MM EXTENSION NORMAL
SAME PATIENT FLEXION 5MM NORMAL
RULE OF 2 ─ 2 mm or less ─ Any movement ─ Usually normal
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
ABNORMAL C1-C2 DISLOCATION
NORMAL NO DISLOCATION
AXIAL LOAD INJURIES –Same as in adults –Usually older children
JEFFERSON FRACTURES –Very rare in infants –Differentiate from synchondroses
NORMAL - PSEUDO OFF SET - UP TO 2 YTS
INFANTS AND CHILDREN ARE HYPERMOBILE
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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