Cervical spine trauma in the injured child: A tragic injury with potentialfor salvageable functional outcome

Background/Purpose: Cervical spine injuries are uncommon in children, and, therefore, presumptive immobilization and diagnosis remain controversial. T he purpose of this study was to review the author's experience with cervica l spine injuries in children to determine the incidence, injury mechanism, pattern of injury, and subsequent functional outcome. Methods: Fifty-two children over a 6-year period (1994 to 1999) with a cerv ical spine injury secondary to blunt trauma were identified (1.3% incidence ). The functional independent measure (FIM) was assessed at the time of dis charge in each of 3 categories: communication, feeding, and locomotion. Results: Mean age of the study children was 10.7 +/- 0.7 years. Eight child ren (15%) were less than 5 years old, and 4 (8%) were less than 2 yea rs ol d. The mechanism of injury included motor vehicle crash (52%), falls (15%), bicycle accidents (11%), sports-related injuries (10%), pedestrian acciden ts (8%), and motorcycle crashes (4%). Seven patients died yielding an overa ll mortality rate of 13%, injuries were distributed along the cervical spin al cord as follows: 5 atlantooccipital dislocations, 28 C1 to C3 injuries, 17 C4 to C7 injuries, and 2 ligamentous injuries. FIM scores were recorded for 18 patients. Seventeen communicated independently, 14 fed themselves in dependently, and 12 had independent locomotive function. Conclusions: Cervical spine injuries occur in children across a spectrum of ages. Although atlanto-occipital dislocation is a highly lethal event, chi ldren with C1 to C7 injuries have a high likelihood of reasonable independe nt functioning. Copyright (C) 2000 by W.B. Saunders Company.