INJURIES OF THE CERVICAL-SPINE IN CHILDREN

Injuries of the spine in children rarely occur. They amount to about 0 .2 % of all fractures and dislocation and to 1.5 to 3 % of all lesions of the spine. The younger an injured child is, the more likely it has sustained a lesion of the upper cervical spine. This spinal segment i n comparison to adults is concerned more often and accounts for 50 % o f all C-spine injuries. Important differences between the adult spine and the spine in the child disappear with the age of 10 years. Later d iagnostics, classification and treatment correspond widely with the pr inciples valid in adults. The knowledge of the normal shape and develo pment of the spine are crucial in avoiding misinterpretations of X-ray films. Typical examples include the confusion of synchondrosis with f ractures or of subluxations of the atlas and the C2/C3 segment with '' true'' instabilities. Relevant lesions always are accompanied by clear clinical symptoms. Specific injuries of the growing axial skeleton ar e lesions of the cartilaginous endplates and ''fractures'' of the sync hondrosis. Atlantooccipital dislocations (AOD) occur typically in chil dren. According to our experiences with 16 AOD we propose - dependent on the direction of dislocation of the occipital condyles - a simplifi ed classification in anterior, posterior a nd completely unstable AOD. In one boy in our series we treated the lesion successfully by tempor ary interal fixation. He presented a massive improvement of initially subtotal neurologic symptoms. Injuries to the synchondrosis of the den s represent another typical lesion in childhood. Four out of 5 childre n treated in our clinic were involved as back seat passengers in head- on motor Vehicle accidents. Three of them were restrained by 4 point c hildren's seat harnesses. For conservative treatment we prefer a halo and plaster-vest for 12 weeks after closed reduction. We recommend ope rative treatment in cases of major dislocation with greater instabilit y where it may be impossible to maintain alignment with halo fxation. Surgical equipment and techniques correspond in detail to those used i n adults. Three of the five children mentioned have been stabilized su ccessfully by anterior screw fixation. Atlantoaxial dislocations (AAD) are devided into translatory and rotatory instabilities. Sagittal dis locations of the atlas in children also need to be fixed by a fusion b etween C1 and CZ. Rotatory instabilities in the acute phase are easy t o reduce and are treated with a halo-fixator. According to our experie nces in two delayed cases anatomical reduction is also possible after months partly by open, partly by closed means. For the lower C-spine l esion with encroachment of the spinal canal and above all ligamentous injuries represent a clear indication for operative treatment because, similar to the adult spine, they do not become stable after close man agement.