PREDICTIVE FACTORS OF THE OUTCOME OF TRAUMATIC CERVICAL-SPINE FRACTURE IN CHILDREN

The uncommon traumatic cervical spine fractures and dislocations were studied in 227 consecutively treated children (1 to 17 years of age). Lower cervical spine injuries (C-3 to C-7) affected 73% of our patient s. However, among the 38 patients younger than 8 years of age, 87% had an injury at the C-3 level or higher (P<.0001). There were 19 fatalit ies (8.4%), all of which were associated with injuries at the C-4 leve l or higher. Of the 11 patients with atlanto-axial fracture or disloca tion, all died soon after the injury. All had an unstable fracture and cord transsection that resulted in cardiorespiratory collapse. Injuri es at the vertebral levels C-1, C-2, C-3, and C-4 were associated with fatality rates of 17%, 9%, 4.3%, and 3.7%, respectively. No fatalitie s were encountered among patients with lesions lower than C-4. The aut hors conclude that the younger the age, the higher the cervical spine injury, and that the fatality rate correlates directly with the level of cervical spine fracture. Copyright (C) 1994 by W.B. Saunders Compan y