Management of cervical spine injuries in young children: lessons learned

Previous studies have shown that the correct use of car safety seats can protect infants and children from vehicular injury. Although child passenger devices are increasingly used in the US, motor vehicle crashes continue to be the leading cause of death and acquired disability in infants and children younger than 14 years of age. These events are likely related, at least in part, to the high percentage of children who are unrestrained or improperly restrained. The authors present 2 cases of severe cervical spine trauma in young children restrained in car safety seats during a motor vehicle crash: 1) a previously healthy 14-month-old girl who was improperly restrained in a forward-facing booster seat secured to the vehicle by a lap belt, and 2) a previously healthy 30-month-old girl who was a rear seat passenger restrained in a car safety seat. This study points out the unique challenges encountered in treating cervical spine injuries in infants and young children, as well as the lessons learned, and emphasizes the significance of continuing efforts to increase family and public awareness regarding the importance of appropriate child safety seat selection and use.

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Cervical Spine Fractures Sustained by Young Children in Forward-Facing Car Seats

PEDIATRICS ◽

10.1542/peds.84.2.348 ◽

1989 ◽

Vol 84 (2) ◽

pp. 348-354

Author(s):

Susan Fuchs ◽

Martha J. Barthel ◽

Ann Marie Flannery ◽

Katherine K. Christoffel

Keyword(s):

Cervical Spine ◽

Young Children ◽

Parent Education ◽

Health Care Professionals ◽

Motor Vehicle ◽

Cervical Spine Injuries ◽

Car Seats ◽

Number Of Children ◽

Car Safety ◽

Safety Seat

Child passenger safety restraint laws have reduced the number of children killed or injured in motor vehicle accidents in the past few years. However, the increased used of child safety seats has brought with it an increase in the misuse of these devices. High cervical spine injuries sustained by five children less than 2 years of age while in forward-facing car seats are described. In the cases of three children, the car safety seat use was correct. Misuse of car seats and anatomic and biomechanical factors in the cervical spines of infants and young children appear to have contributed to the occurrence of these previously rare injuries. Like seat belts, car safety seats are now a factor in child passenger injury characteristics, and therefore, car safety seat design merits reevaluation. In light of this development, public and parent education by health care professionals concerning the correct use of car safety seats is necessary.

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Cervical spine injuries in young children: pattern and outcomes in accidental versus inflicted trauma

Journal of Surgical Research ◽

10.1016/j.jss.2017.06.053 ◽

2017 ◽

Vol 219 ◽

pp. 366-373 ◽

Cited By ~ 4

Author(s):

Joanne Baerg ◽

Arul Thirumoorthi ◽

Rajaie Hazboun ◽

Rosemary Vannix ◽

Paul Krafft ◽

...

Keyword(s):

Cervical Spine ◽

Young Children ◽

Cervical Spine Injuries ◽

Spine Injuries

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The misdiagnosis of acute cervical spine injuries and fractures in infants and children: the 12-year experience of a level I pediatric and adult trauma center

Child s Nervous System ◽

10.1007/s00381-004-1058-4 ◽

2004 ◽

Vol 21 (2) ◽

pp. 122-127 ◽

Cited By ~ 54

Author(s):

Anthony M. Avellino ◽

Fred A. Mann ◽

M. Sean Grady ◽

Jens R. Chapman ◽

Richard G. Ellenbogen ◽

...

Keyword(s):

Cervical Spine ◽

Trauma Center ◽

Infants And Children ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Level I ◽

In Infants And Children

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Car Crashes and Non-Head Impact Cervical Spine Injuries in Infants and Children

10.4271/920562 ◽

1992 ◽

Cited By ~ 14

Author(s):

Donald F. Huelke ◽

G. Murray Mackay ◽

Andrew Morris ◽

Maureen Bradford

Keyword(s):

Cervical Spine ◽

Head Impact ◽

Infants And Children ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Car Crashes ◽

In Infants And Children

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Detection of Cervical Spine Injuries in Alert, Asymptomatic Geriatric Blunt Trauma Patients: Who Benefits from Radiologic Imaging?

The American Surgeon ◽

10.1177/000313480607200903 ◽

2006 ◽

Vol 72 (9) ◽

pp. 773-777 ◽

Cited By ~ 1

Author(s):

Adrian W. Ong ◽

Aurelio Rodriguez ◽

Robert Kelly ◽

Vicente Cortes ◽

Jack Protetch ◽

...

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Blunt Trauma ◽

Cervical Spine Injury ◽

Motor Vehicle ◽

Spine Injury ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Anatomic Locations

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 ± 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.

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Effect of age on cervical spine injuries in children after motor vehicle collisions: effectiveness of restraint devices

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2003.11.046 ◽

2004 ◽

Vol 39 (3) ◽

pp. 483-486 ◽

Cited By ~ 24

Author(s):

Brian S Zuckerbraun ◽

Katie Morrison ◽

Barbara Gaines ◽

Henri R Ford ◽

David J Hackam

Keyword(s):

Cervical Spine ◽

Motor Vehicle ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Effect Of Age

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Chronic Neck Pain Associated with an Old Odontoid Fracture: A Rare Presentation

Case Reports in Emergency Medicine ◽

10.1155/2013/372723 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Mauricio Avila-Guerra

Keyword(s):

Cervical Spine ◽

Neurological Deficit ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Odontoid Fracture ◽

Motor Vehicles ◽

Rare Presentation ◽

Cervical Spine Injuries ◽

Wide Range ◽

Spine Injuries

Cervical spine injuries represent a minority of injury cases in motor vehicles accidents but are a real threat to a patient’s life. In the wide range of cervical spine injuries, odontoid (dens) fractures represent the most common findings. These fractures are more usually found in the elderly population due to the changes associated with age. Neurological deficit is not frequently found in these injuries. The following is a case presentation of a chronic odontoid fracture with neurological deficit in a young man that was discovered 23 years after he sustained a motor vehicle accident.

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Pediatric subaxial cervical spine injuries: origins, management, and outcome in 51 patients

Neurosurgical FOCUS ◽

10.3171/foc.2006.20.2.2 ◽

2006 ◽

Vol 20 (2) ◽

pp. 1-7 ◽

Cited By ~ 40

Author(s):

Seref Dogan ◽

Sam Safavi-Abbasi ◽

Nicholas Theodore ◽

Eric Horn ◽

Harold L. Rekate ◽

...

Keyword(s):

Cervical Spine ◽

Spinal Cord Injuries ◽

Motor Vehicle ◽

Fracture Dislocation ◽

Cervical Spine Injuries ◽

Factors Affecting ◽

Vehicle Accidents ◽

Subaxial Cervical Spine ◽

Cervical Orthosis ◽

Spine Injuries

Object In this study the authors evaluated the mechanisms and patterns of injury and the factors affecting management and outcome of pediatric subaxial cervical spine injuries (C3–7). Methods Fifty-one pediatric patients (38 boys and 13 girls; mean age 12.4 years, range 10 months–16 years) with subaxial cervical spine injuries were reviewed retrospectively. Motor vehicle accidents (MVAs) were the most common cause of injury. Overall, 12% presented with a dislocation, 63% with a fracture, 19% with a fracture–dislocation, and 6% with a ligamentous injury. The most frequently injured level was C6–7 (33%); C3–4 (6%) was least frequently involved. Sixty-four percent of patients were neurologically intact, 16% had incomplete spinal cord injuries (SCIs), 14% had complete SCIs, and three patients (6%) died after admission and before assessment. Treatment was conservative in 64%: seven (13%) wore a halo vest and 26 (51%) wore a rigid cervical orthosis. Surgery was performed in the other 18 patients (36%), with the breakdown as follows: 15 (30%) underwent an anterior approach, two (4%) had posterior approaches, and one (2%) had a combined approach. Postoperatively, four patients (8%) who had a neurological deficit improved. The overall mortality rate was 8%; all deaths were related to MVAs. There were no surgery-related deaths or complications. Conclusions Subaxial cervical spine injuries are common in children 9 to 16 years of age, and occur principally between C-5 and C-7. Multilevel injury is more common in children 8 years of age and older than in younger children and infants. Most patients with subaxial cervical spine injuries can be treated conservatively. Both anterior and posterior approaches are safe and effective.

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