Cervical injury (peds): Difference between revisions

Latest revision as of 22:52, 28 November 2019

This page is for pediatric patients. For adult patients, see: cervical spine injury

Background

C-spine injury uncommon in children but large head in age <8 creates system for upper cervical injury
Injuries most feared include atlanto-occipital dissociation (AOD) and atlantoaxial rotatory subluxation or fixation (AARF).

SCIWORA

Spinal cord injury without radiographic abnormality
Exam findings of myelopathy without abnormalities on XR or CT

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
AOD- can be devastating injury or even fatal

Differential Diagnosis

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

Evaluation

Algorithm for the evaluation of pediatric cervical spine injuries

C-Spine Clearance Without Imaging

<3 years old

GCS>13
no neurological deficit
no midline cervical tenderness to palpation
no painful distracting injury
no unexplained hypotension
not intoxicated
mechanism-image if: MVC, fall >10 feet, non-accidental trauma known or suspected

>3 years old

alert
no neurological deficit
no midline cervical ttp
no painful distracting injury
no unexplained hypotension
not intoxicated

Imaging

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)

AOD- CT to look for condyle-C1 interval (CCI)
AARF- C1-C2 motion analysis to characterize injury(3 position CT)
Plain films otherwise acceptable

SCIWORA- full spinal column radiographic 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.
Neurosurgery consult for abnormalities

References

EB Medicine- EM Practice Guideline Update- Sept 2014- Updated Guidelines For Management Of Acute Cervical Spine And Spinal Cord Injury In Pediatric Patients
American Association of Neurological Surgeons and Congress of Neurological Surgeons in 2013.

Authors:

@@ Line 1: / Line 1: @@
+{{Peds top}} [[cervical spine injury]]
 ==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.
+*C-spine injury uncommon in children but large head in age <8 creates system for upper cervical injury
+*Injuries most feared include [[atlanto-occipital dissociation]] (AOD) and atlantoaxial rotatory subluxation or fixation (AARF).
+===SCIWORA===
+*Spinal cord injury without radiographic abnormality
+*Exam findings of myelopathy without abnormalities on XR or CT
 ==Clinical Features==
-*Blunt trauma in pediatric population.
+*[[blunt neck trauma|Blunt trauma]] in pediatric population.
 *AARF- may occur spontaneously or in trauma- exam shows head rotated, tilted or unable to turn past midline
+*AOD- can be devastating injury or even fatal
-==C-Spine Clearance Without Imaging==
+==Differential Diagnosis==
-*>3 years old
+{{Cervical spine injuries}}
-#alert
-#no neurological deficit
-#no midline cervical ttp
-#no painful distracting injury
-#no unexplained hypotension
-#not intoxicated
-*<3 years old
+==Evaluation==
-#GCS>13
+[[File:Pediatric cspine.png|thumb|Algorithm for the evaluation of pediatric cervical spine injuries]]
-#no neurological deficit
+===C-Spine Clearance Without Imaging===
-#no midline cervical ttp
+====<3 years old====
-#no painful distracting injury
+*[[GCS (Peds)|GCS]]>13
-#no unexplained hypotension
+*no neurological deficit
-#not intoxicated
+*no midline cervical tenderness to palpation
-#mechanism--not MVC, fall >10 feet, non-accidental trauma known or suspected
+*no painful distracting injury
+*no unexplained hypotension
+*not intoxicated
+*mechanism-image if: MVC, fall >10 feet, non-accidental trauma known or suspected
-==SCIWORA==
+====>3 years old====
-*Spinal cord injury without radiographic abnormality
+*alert
-*Exam findings of myelopathy without abnormalities on XR or CT
+*no neurological deficit
+*no midline cervical ttp
+*no painful distracting injury
+*no unexplained hypotension
+*not intoxicated
-==Workup==
+===Imaging===
-*No imaging if above criteria met based upon age.
+''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
+#AOD- CT to look for condyle-C1 interval (CCI)
-*SCIWORA- full spinal column radiographical imaging
+#AARF- C1-C2 motion analysis to characterize injury(3 position CT)
+#Plain films otherwise acceptable
+*SCIWORA- full spinal column radiographic imaging
 **MRI of suspected area of spinal damage
 **Assess spinal stability acutely and in follow-up with flex/ex films
@@ Line 38: / Line 48: @@
 ==Management==
 *Immobilization must account for relatively larger occiput using occipital recess or thoracic elevation to maintain c-spine neutrality.
+*Neurosurgery consult for abnormalities
 ==See Also==
-*C-spine (nexus)
+{{Head Trauma Links Template}}
-==Sources==
+==References==
 *EB Medicine- EM Practice Guideline Update- Sept 2014- Updated Guidelines For Management Of Acute Cervical Spine And Spinal Cord Injury In Pediatric Patients
+*American Association of Neurological Surgeons and Congress of Neurological Surgeons in 2013.
+[[Category:Pediatrics]]
+[[Category:Trauma]]
+[[Category:Neurology]]