Pediatric cervical spine injuries: report of 102 cases and review of the literature

Object. To evaluate and review their experience with pediatric cervical inj uries and factors affecting outcome, the authors conducted a retrospective clinical study of 102 cases (65% boys, 35% girls) of pediatric cervical spi ne injuries treated in the last decade. This study is an extension of and c omparison with their earlier experience. Methods. Patients were divided into two age groups-birth to 9 years (Group 1) and 10 to 16 years of age (Group 2)and managed according to status at pr esentation and type of injury. Thirty patients were managed surgically and 72 nonsurgically (42 wore a halo brace and 30 wore hard collars or custom-m olded braces). Motor vehicle accidents were the most common cause of injury, and 40% were associated with head injury. Patients in the younger-age group (Group 1) su stained more neurological injuries than the older patients in Group 2, and most injuries were in the upper cervical spine. Of the 38 children in Group 1, in 39% a subluxation was present and in 29% a fracture or fractures/sub luxation was demonstrated. Of the patients in Group 2. 8% had sustained fra ctures or fracture/subluxations. Vertebral fractures were the most common r adiological findings (32%). At late follow-up review (mean 5 years), solid fusions were demonstrated in all patients. Neurological deterioration did n ot occur in any patient. The mortality rate was 16%. Compared with the auth ors' earlier report, the incidence of cases with pediatric cervical injurie s increased, as did the number managed surgically. Various fusion technique s were used, and neurological and fusion outcomes improved as compared with the previous report. Conclusions. The prognosis of neurological recovery from pediatric cervical spine injuries is related to the severity of the initial neurological inju ry. Management must be tailored to the patient's age, neurological status, and type and level of injury. Compared with our earlier experience, fusion and instrumentation procedures were used more frequently. Different types o f fusion and instrumentation procedures can be performed safely in children and produce good outcomes.