Evaluation of pediatric cervical spine injuries

To compare historical features, clinical examination findings, and radiogra phic results among pediatric patients with cervical spine injury (CSI), a r etrospective review of patients who were diagnosed with CSI was undertaken. Two main groups were identified: radiographically evident cervical spine i njury (RESCI), and spinal cord injury without radiographic abnormality (SCI WORA). Demographic, historical, clinical, and radiographic information was obtained from patients' charts and analyzed to determine factors associated with CSI and to determine the efficacy of the various radiographic views. Seventy two children, ages from 1 month to 15 years (median age, 9 yrs), we re included in the study. Sports related injuries were the most common. For ty patients had RESCI and 32 had SCIWORA. Forty nine (80%) of all the patie nts had abnormal findings on neck examination, and six (16%) of the RECSI g roup had abnormal neurological findings. Lateral radiographs had a sensitiv ity for CSI of 79%; a three-view radiographic series had a sensitivity of 9 4%. All patients with CSI who were clinically asymptomatic had both a high risk injury mechanism and a distracting injury. CSI should be suspected in any child with abnormal findings on neck or neurological examination. A min imum of three radiographic cervical spine views should be obtained in the e valuation of CSI in children. Even in the face of a three view series, CSI should be suspected in patients with an abnormal neck or neurological exam, high-risk mechanism of injury, or distracting injury. Copyright (C) 1999 b y W.B. Saunders Company.