Characteristics of pediatric cervical spine injuries

Purpose: The objective of this study was to assess the mechanisms and patte rns of injury and outcome in children with cervical (C) spine trauma. Methods: We reviewed the National Pediatric Trauma Registry between April 1 994 and March 1999 and identified (by ICD-9 criteria) all cases of blunt tr auma victims with cervical fractures, dislocations, and spinal cord injurie s without radiographic abnormality (SCIWORA). Data are shown as mean +/- SE M. Results: During the 5-year period, the incidence of blunt C-spine injury wa s 1.6% (n = 408 of 24,740 total entries). Mean age was 10.5 +/- 0.3 (1 to 2 0) years, and 59% were boys. Leading mechanisms were motor vehicle accident s (n = 179; 44%), sports (n = 66; 16%), and pedestrian injuries (n = 57, 14 %). Younger (less than or equal to 10 years) children more often sustained high (C1 to C4) vs low (C5 to C7) injuries (85% v 57%; P<.01) and also had a higher incidence of dislocations (31% v 20%; P<.01) and cord injuries (26 % v 14%; P<.01), whereas older children had more C-spine fractures (66% v 4 3%; P< 0.01), Mortality rates (overall, 17%) were higher in younger childre n (n = 180) when compared with older children (n = 228; 30% v 7%; P <.01). Overall, the majority of deaths (93%) were associated with brain injuries. No children with cervical dislocations had neurologic sequelae. The prepond erance of children with fractures (83%) also were without neurologic injury , whereas those associated with SCIWORA usually were (80%) partial. Overall , complete cord lesions were infrequent (4%). Conclusions: These data, representing the largest series to date, confirm t hat blunt C-spine injuries in children are rare. Patterns of injury vary si gnificantly according to child age. Major neurologic sequelae in survivors is uncommon, does not correlate well with cord level, and rarely is complet e. J Pediatr Surg 36:100-105. Copyright (C) 2001 by W.B. Saunders Company.