Cervical spine trauma in children: Part I. General concepts, normal anatomy, radiographic evaluation

Abstract

It is frequently the responsibility of emergency physicians to perform the initial assessment of trauma victims and evaluate for possible cervical spine injury (CSI). In these cases, defining the anatomic and functional status of the cervical spine takes precedent after performing any necessary resuscitative measures. It requires a skill based on both knowledge and experience to accurately and expeditiously evaluate for possible cervical spine injury while ensuring controlled spinal alignment in a neutral position. The consequences of an unrecognized CSI can obviously be disastrous. It has been shown that as many as 60% of all cervical spinal cord lesions are initially incomplete postinjury, and that 5% to 10% of lesions occur after the traumatic event during the early phases of emergency care.‘-4 In a series of 300 multiple trauma victims with CSI, 11 victims had an initially unrecognized lesion and experienced neurologic deficit or death as a result of inadequate neck immobilization during the course of emergency management.’ In order to maximize the outcome of trauma victims with CSI it is incumbent on the managing physician to have a thorough understanding of the anatomy and biomechanics of the normal cervical spine and of the pathologic manifestations of CSI that can result from a myriad of traumatic events. This two-part article will review anatomic and biomechanical aspects of the cervical spine, describe common pediatric CSIs, demonstrate associated mechanisms and radiographic manifestations of CSIs, and propose guidelines for the initial clinical assessment and management of trauma victims evaluated for possible CSI.