Cervical injury (peds): Difference between revisions

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==Background==
==Background==
C-spine injury uncommon in children but large head in age <8 create system for upper cervical injury. Injuries most feared include atlanto-occipital dislocation(AOD) and atlantoaxial rotatory subluxation or fixation (AARF) which can be fatal. Guidelines come from American Association of Neurological Surgeons and Congress of Neurological Surgeons in 2013.
C-spine injury uncommon in children but large head in age <8 create system for upper cervical injury. Injuries most feared include atlanto-occipital dislocation(AOD) and atlantoaxial rotatory subluxation or fixation (AARF). Guidelines come from American Association of Neurological Surgeons and Congress of Neurological Surgeons in 2013.


==Clinical Features==
==Clinical Features==

Revision as of 19:40, 8 September 2014

Background

C-spine injury uncommon in children but large head in age <8 create system for upper cervical injury. Injuries most feared include atlanto-occipital dislocation(AOD) and atlantoaxial rotatory subluxation or fixation (AARF). Guidelines come from American Association of Neurological Surgeons and Congress of Neurological Surgeons in 2013.

Clinical Features

  • Blunt trauma in pediatric population.
  • AARF- may occur spontaneously or in trauma- exam shows head rotated, tilted or unable to turn past midline

C-Spine Clearance Without Imaging

  • >3 years old
  1. alert
  2. no neurological deficit
  3. no midline cervical ttp
  4. no painful distracting injury
  5. no unexplained hypotension
  6. not intoxicated
  • <3 years old
  1. GCS>13
  2. no neurological deficit
  3. no midline cervical ttp
  4. no painful distracting injury
  5. no unexplained hypotension
  6. not intoxicated
  7. mechanism--not MVC, fall >10 feet, non-accidental trauma known or suspected

Workup

  • No imaging if above criteria met based upon age.
  • CT c-spine for concern of Atlanto-occipital dislocation(AOD) or atlantoaxial rotatory subluxation or fixation (AARF)
    • Plain films otherwise acceptable
  • SCIWORA- full spinal column radiographical imaging
    • MRI of suspected area of spinal damage
    • Assess spinal stability acutely and in follow-up with flex/ex films

Management

  • Immobilization must account for relatively larger occiput using occipital recess or thoracic elevation to maintain c-spine neutrality.

See Also

  • C-spine (nexus)

Sources

  • EB Medicine- EM Practive Guideline Update- Sept 2014- Updated Guidelines For Management Of Acute Cervical Spine And Spinal Cord Injury In Pediatric Patients