Cervical injury (peds): Difference between revisions
Kurtucla05 (talk | contribs) |
Kurtucla05 (talk | contribs) (→Workup) |
||
Line 31: | Line 31: | ||
*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) | *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 on CT to characterize injury(three positions) | |||
#Plain films otherwise acceptable | |||
*SCIWORA- full spinal column radiographical imaging | *SCIWORA- full spinal column radiographical imaging | ||
**MRI of suspected area of spinal damage | **MRI of suspected area of spinal damage |
Revision as of 19:50, 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
- alert
- no neurological deficit
- no midline cervical ttp
- no painful distracting injury
- no unexplained hypotension
- not intoxicated
- <3 years old
- GCS>13
- no neurological deficit
- no midline cervical ttp
- no painful distracting injury
- no unexplained hypotension
- not intoxicated
- mechanism--not MVC, fall >10 feet, non-accidental trauma known or suspected
SCIWORA
- Spinal cord injury without radiographic abnormality
- Exam findings of myelopathy without abnormalities on XR or CT
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)
- AOD- CT to look for condyle-C1 interval (CCI)
- AARF- C1-C2 motion analysis on CT to characterize injury(three positions)
- 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 Practice Guideline Update- Sept 2014- Updated Guidelines For Management Of Acute Cervical Spine And Spinal Cord Injury In Pediatric Patients