Skip to main content
SpringerLink
Log in

Pediatric Spine Trauma

  • Chapter
The Growing Spine

Abstract

Pediatric spine trauma is an important cause of morbidity and mortality in the pediatric population. The unique features of the pediatric spine lead to specific injury patterns and differentiate these injuries from those of adult patients. Increased ligamentous laxity, horizontal orientation of vertebral facets, wedge-shaped vertebral body, and underdeveloped paraspinal muscles in the immature spine result in a relatively high incidence of cervical spine injuries. Common pediatric spine injuries include odontoid fractures, spinal cord injury without radiographic abnormalities (SCIWORA), atlantoaxial instability, compression fractures, thoracolumbar burst fractures, and flexion-distraction injuries. Pediatric spine injuries are commonly associated with high-energy trauma and high level of suspicion is necessary for concomitant thoracic or abdominal injuries. The management of pediatric spine trauma should take into consideration not only the unique pediatric spine anatomy but also the growth potential of this patient population. Finally, as with all injuries in the pediatric population, prevention is of utter importance with special attention given to proper use of seatbelts and child safety as well as use of appropriate sporting equipment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. d’Amato C (2005) Pediatric spinal trauma: injuries in very young children. Clin Orthop Relat Res 432:34–40

    Article  PubMed  Google Scholar 

  2. Hamilton MG, Myles ST (1992) Pediatric spinal injury: review of 174 hospital admissions. J Neurosurg 77(5):700–704

    Article  CAS  PubMed  Google Scholar 

  3. Rekate HL et al (1999) Pediatric spine and spinal cord trauma. State of the art for the third millennium. Childs Nerv Syst 15(10603016):743–750

    Article  CAS  PubMed  Google Scholar 

  4. Knox JB et al (2014) Spine trauma in very young children: a retrospective study of 206 patients presenting to a level 1 pediatric trauma center. J Pediatr Orthop 34(7):698–702

    Article  PubMed  Google Scholar 

  5. Nitecki S, Moir CR (1994) Predictive factors of the outcome of traumatic cervical spine fracture in children. J Pediatr Surg 29(7844708):1409–1411

    Article  CAS  PubMed  Google Scholar 

  6. Parent S et al (2010) Unique features of pediatric spinal cord injury. Spine (Phila Pa 1976) 35(21 Suppl):S202–S208

    Article  Google Scholar 

  7. Eleraky MA et al (2000) Pediatric cervical spine injuries: report of 102 cases and review of the literature. J Neurosurg 92(1 Suppl):12–17

    CAS  PubMed  Google Scholar 

  8. Eubanks JD et al (2006) Clearing the pediatric cervical spine following injury. J Am Acad Orthop Surg 14(9):552–564

    PubMed  Google Scholar 

  9. Osenbach RK, Menezes AH (1992) Pediatric spinal cord and vertebral column injury. Neurosurgery 30(1620302):385–390

    Article  CAS  PubMed  Google Scholar 

  10. Hadley MN et al (1988) Pediatric spinal trauma. Review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 68(3335907):18–24

    Article  CAS  PubMed  Google Scholar 

  11. Brown RL, Brunn MA, Garcia VF (2001) Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 36(11479837):1107–1114

    Article  CAS  PubMed  Google Scholar 

  12. Kokoska ER et al (2001) Characteristics of pediatric cervical spine injuries. J Pediatr Surg 36(11150446):100–105

    Article  CAS  PubMed  Google Scholar 

  13. Patel JC et al (2001) Pediatric cervical spine injuries: defining the disease. J Pediatr Surg 36(11172438):373–376

    Article  CAS  PubMed  Google Scholar 

  14. Leonard JR et al (2014) Cervical spine injury patterns in children. Pediatrics 133(5):e1179–e1188

    Article  PubMed  Google Scholar 

  15. Copley LA, Dormans JP (1998) Cervical spine disorders in infants and children. J Am Acad Orthop Surg 6(9682083):204–214

    CAS  PubMed  Google Scholar 

  16. Dormans JP (2002) Evaluation of children with suspected cervical spine injury. J Bone Joint Surg Am 84-A(1):124–132

    PubMed  Google Scholar 

  17. Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 8(6670016):817–831

    Article  CAS  Google Scholar 

  18. Farley FA, Hensinger RN, Herzenberg JE (1992) Cervical spinal cord injury in children. J Spinal Disord 5(1490038):410–416

    Article  CAS  PubMed  Google Scholar 

  19. Vaccaro AR (2005) Orthopaedic knowledge update, 8th edn. American Academy of Orthopaedic Surgeons, Rosemont, IL

    Google Scholar 

  20. Vachhrajani S et al (2014) Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group. J Neurosurg Pediatr 14(4):425–433

    Article  PubMed  Google Scholar 

  21. Lustrin ES et al (2003) Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics 23(12740460):539–560

    Article  PubMed  Google Scholar 

  22. Lee SL et al (2003) A multidisciplinary approach to the development of a cervical spine clearance protocol: process, rationale, and initial results. J Pediatr Surg 38(3):358–362; discussion 358–362

    Article  PubMed  Google Scholar 

  23. Herzenberg JE et al (1989) Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg Am 71(2912996):15–22

    CAS  PubMed  Google Scholar 

  24. Copley LAB et al (2003) Accuracy and reliability of torque wrenches used for halo application in children. J Bone Joint Surg Am 85-A(14630853):2199–2204

    PubMed  Google Scholar 

  25. Dormans JP et al (1995) Complications in children managed with immobilization in a halo vest. J Bone Joint Surg Am 77(7673288):1370–1373

    CAS  PubMed  Google Scholar 

  26. Ralston ME et al (2001) Role of flexion-extension radiographs in blunt pediatric cervical spine injury. Acad Emerg Med 8(11229945):237–245

    Article  CAS  PubMed  Google Scholar 

  27. Wiesel SW, Rothman RH (1979) Occipitoatlantal hypermobility. Spine (Phila Pa 1976) 4(472888):187–191

    Article  CAS  Google Scholar 

  28. Shaw M et al (1999) Pseudosubluxation of C2 on C3 in polytraumatized children – prevalence and significance. Clin Radiol 54(6):377–380

    Article  CAS  PubMed  Google Scholar 

  29. Cattell HS, Filtzer DL (1965) Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Joint Surg Am 47(5837630):1295–1309

    CAS  PubMed  Google Scholar 

  30. Roche C, Carty H (2001) Spinal trauma in children. Pediatr Radiol 31(11685436):677–700

    Article  CAS  PubMed  Google Scholar 

  31. Jones TM, Anderson PA, Noonan KJ (2011) Pediatric cervical spine trauma. J Am Acad Orthop Surg 19(10):600–611

    PubMed  Google Scholar 

  32. Flynn JM et al (2002) Role of magnetic resonance imaging in the assessment of pediatric cervical spine injuries. J Pediatr Orthop 22(5):573–577

    PubMed  Google Scholar 

  33. Steinmetz MP, Lechner RM, Anderson JS (2003) Atlantooccipital dislocation in children: presentation, diagnosis, and management. Neurosurg Focus 14(2):1–7

    Article  Google Scholar 

  34. Cohen MW et al (2001) A technique of occipitocervical arthrodesis in children using autologous rib grafts. Spine (Phila Pa 1976) 26(11295907):825–829

    Article  CAS  Google Scholar 

  35. Hosalkar HS et al (2005) Traumatic atlanto-occipital dislocation in children. J Bone Joint Surg Am 87(16264124):2480–2488

    Article  PubMed  Google Scholar 

  36. Powers B et al (1979) Traumatic anterior atlanto-occipital dislocation. Neurosurgery 4(450210):12–17

    Article  CAS  PubMed  Google Scholar 

  37. Eismont FJ, Bohlman HH (1978) Posterior atlanto-occipital dislocation with fractures of the atlas and odontoid process. J Bone Joint Surg Am 60(649646):397–399

    CAS  PubMed  Google Scholar 

  38. Georgopoulos G, Pizzutillo PD, Lee MS (1987) Occipito-atlantal instability in children. A report of five cases and review of the literature. J Bone Joint Surg Am 69(3818705):429–436

    CAS  PubMed  Google Scholar 

  39. Levine AM, Edwards CC (1991) Fractures of the atlas. J Bone Joint Surg Am 73(2045393):680–691

    CAS  PubMed  Google Scholar 

  40. Spence KF, Decker S, Sell KW (1970) Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am 52(5425648):543–549

    PubMed  Google Scholar 

  41. Bayar MA et al (2002) Isolated anterior arch fracture of the atlas: child case report. Spine (Phila Pa 1976) 27(11805680):47–49

    Article  Google Scholar 

  42. Korinth MC, Kapser A, Weinzierl MR (2007) Jefferson fracture in a child – illustrative case report. Pediatr Neurosurg 43(17992046):526–530

    Article  PubMed  Google Scholar 

  43. Kontautas E et al (2005) Management of acute traumatic atlas fractures. J Spinal Disord Tech 18(16189450):402–405

    Article  PubMed  Google Scholar 

  44. Lee TT, Green BA, Petrin DR (1998) Treatment of stable burst fracture of the atlas (Jefferson fracture) with rigid cervical collar. Spine (Phila Pa 1976) 23(18):1963–1967

    Article  CAS  Google Scholar 

  45. Smith WS, Kaufer H (1969) Patterns and mechanisms of lumbar injuries associated with lap seat belts. J Bone Joint Surg Am 51(5767317):239–254

    CAS  PubMed  Google Scholar 

  46. Fassett DR, McCall T, Brockmeyer DL (2006) Odontoid synchondrosis fractures in children. Neurosurg Focus 20(2):1–4

    Google Scholar 

  47. Odent T et al (1999) Fractures of the odontoid process: a report of 15 cases in children younger than 6 years. J Pediatr Orthop 19(9890287):51–54

    CAS  PubMed  Google Scholar 

  48. Sherburn EW et al (1996) Subdental synchondrosis fracture in children: the value of 3-dimensional computerized tomography. Pediatr Neurosurg 25(9309790):256–259

    Article  CAS  PubMed  Google Scholar 

  49. Sherk HH, Nicholson JT, Chung SM (1978) Fractures of the odontoid process in young children. J Bone Joint Surg Am 60(701339):921–924

    CAS  PubMed  Google Scholar 

  50. Ranjith RK, Mullett JH, Burke TE (2002) Hangman’s fracture caused by suspected child abuse. A case report. J Pediatr Orthop B 11(12370585):329–332

    PubMed  Google Scholar 

  51. Levine AM, Edwards CC (1985) The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 67(3968113):217–226

    CAS  PubMed  Google Scholar 

  52. Phillips WA, Hensinger RN (1989) The management of rotatory atlanto-axial subluxation in children. J Bone Joint Surg Am 71(2732254):664–668

    CAS  PubMed  Google Scholar 

  53. Fielding JW, Hawkins RJ (1977) Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 59(833172):37–44

    CAS  PubMed  Google Scholar 

  54. Rahimi SY et al (2003) Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus 15(6):1–4

    Article  Google Scholar 

  55. Pang D, Wilberger JE Jr (1982) Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57(1):114–129

    Article  CAS  PubMed  Google Scholar 

  56. Pang D, Pollack IF (1989) Spinal cord injury without radiographic abnormality in children – the SCIWORA syndrome. J Trauma 29(2724383):654–664

    Article  CAS  PubMed  Google Scholar 

  57. Grabb PA, Pang D (1994) Magnetic resonance imaging in the evaluation of spinal cord injury without radiographic abnormality in children. Neurosurgery 35(3):406–414; discussion 414

    Article  CAS  PubMed  Google Scholar 

  58. Platzer P et al (2007) Cervical spine injuries in pediatric patients. J Trauma 62(17297330):389–396

    Article  PubMed  Google Scholar 

  59. Akbarnia BA (1999) Pediatric spine fractures. Orthop Clin North Am 30(3):521–536, x

    Article  CAS  PubMed  Google Scholar 

  60. Clark P, Letts M (2001) Trauma to the thoracic and lumbar spine in the adolescent. Can J Surg 44(11603746):337–345

    PubMed Central  CAS  PubMed  Google Scholar 

  61. Carreon LY, Glassman SD, Campbell MJ (2004) Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech 17(6):477–482

    Article  PubMed  Google Scholar 

  62. Junewick JJ, Borders HL, Davis AT (2014) Pediatric thoracic spine injuries: a single-institution experience. AJR Am J Roentgenol 203(3):649–655

    Article  PubMed  Google Scholar 

  63. Reilly CW (2007) Pediatric spine trauma. J Bone Joint Surg Am 89 Suppl 1(17272427):98–9107

    Article  PubMed  Google Scholar 

  64. Sovio OM et al (1985) Fracture of the lumbar vertebral apophysis. J Pediatr Orthop 5(2931450):550–552

    Article  CAS  PubMed  Google Scholar 

  65. Santiago R et al (2006) The clinical presentation of pediatric thoracolumbar fractures. J Trauma 60(1):187–192

    Article  PubMed  Google Scholar 

  66. Daniels AH, Sobel AD, Eberson CP (2013) Pediatric thoracolumbar spine trauma. J Am Acad Orthop Surg 21(12):707–716

    Article  PubMed  Google Scholar 

  67. Leypold BG et al (2007) The impact of methylprednisolone on lesion severity following spinal cord injury. Spine (Phila Pa 1976) 32(3):373–378; discussion 379–381

    Article  Google Scholar 

  68. Bracken MB et al (1998) Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up. Results of the third National Acute Spinal Cord Injury randomized controlled trial. J Neurosurg 89(9817404):699–706

    Article  CAS  PubMed  Google Scholar 

  69. Sayer FT, Kronvall E, Nilsson OG (2006) Methylprednisolone treatment in acute spinal cord injury: the myth challenged through a structured analysis of published literature. Spine J 6(16651231):335–343

    Article  PubMed  Google Scholar 

  70. Pettiford JN et al (2012) A review: the role of high dose methylprednisolone in spinal cord trauma in children. Pediatr Surg Int 28(3):287–294

    Article  PubMed  Google Scholar 

  71. Edwards CC, Levine AM (1986) Early rod-sleeve stabilization of the injured thoracic and lumbar spine. Orthop Clin North Am 17(1):121–145

    CAS  PubMed  Google Scholar 

  72. Ni WF et al (2010) Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech 23(8):530–537

    Article  PubMed  Google Scholar 

  73. Ilharreborde B et al (2012) Circumferential fusion with anterior strut grafting and short-segment multipoint posterior fixation for burst fractures in skeletally immature patients: a preliminary report. J Pediatr Orthop 32(5):440–444

    Article  PubMed  Google Scholar 

  74. Dogan S et al (2007) Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases. J Neurosurg 106(17566397):426–433

    PubMed  Google Scholar 

  75. McPhee IB (1981) Spinal fractures and dislocations in children and adolescents. Spine (Phila Pa 1976) 6(7336275):533–537

    Article  CAS  Google Scholar 

  76. Parisini P, Di Silvestre M, Greggi T (2002) Treatment of spinal fractures in children and adolescents: long-term results in 44 patients. Spine (Phila Pa 1976) 27(12634558):1989–1994

    Article  Google Scholar 

  77. Moller A et al (2006) Vertebral fractures in late adolescence: a 27 to 47-year follow-up. Eur Spine J 15(16395616):1247–1254

    Article  PubMed Central  PubMed  Google Scholar 

  78. Erfani MA et al (2014) Results of fusion and instrumentation of thoracic and lumbar vertebral fractures in children: a prospective ten-year study. Musculoskelet Surg 98(2):107–114

    Article  CAS  PubMed  Google Scholar 

  79. Dearolf WW et al (1990) Scoliosis in pediatric spinal cord-injured patients. J Pediatr Orthop 10(2312704):214–218

    Article  PubMed  Google Scholar 

  80. Lancourt JE, Dickson JH, Carter RE (1981) Paralytic spinal deformity following traumatic spinal-cord injury in children and adolescents. J Bone Joint Surg Am 63(7451526):47–53

    CAS  PubMed  Google Scholar 

  81. Mehta S et al (2004) Effect of bracing on paralytic scoliosis secondary to spinal cord injury. J Spinal Cord Med 27(Suppl 1):S88–S92

    PubMed  Google Scholar 

  82. Angelliaume A et al (2015) Post-trauma scoliosis after conservative treatment of thoracolumbar spinal fracture in children and adolescents: results in 48 patients. [Epub ahead of print]. PMID: 25572148

    Google Scholar 

  83. Riordan A et al (2015) Psychosocial outcomes among youth with spinal cord injury by neurological impairment. J Spinal Cord Med 38(1):76–83

    Article  PubMed  Google Scholar 

  84. Hwang M et al (2014) Longitudinal employment outcomes in adults with pediatric-onset spinal cord injury. Spinal Cord 52(6):477–482

    Article  CAS  PubMed  Google Scholar 

  85. Durbin DR (2011) Child passenger safety. Pediatrics 127(4):788–793

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Wood Building 2nd Floor, Philadelphia, PA, 19104, USA

    Emmanouil Grigoriou MD

  2. Division of Orthopaedic Surgery, Texas Children’s Hospital, 6701 Fannin St CC660, Houston, TX, 77030, USA

    John P. Dormans MD, FACS

Authors
  1. Emmanouil Grigoriou MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John P. Dormans MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John P. Dormans MD, FACS .

Editor information

Editors and Affiliations

  1. San Diego Center for Spinal Disorders Medical Group, Inc., La Jolla, California, USA

    Behrooz A. Akbarnia

  2. Hacettepe University Dept. Orthopedics & Traumatology, Sihhiye, Ankara, Turkey

    Muharrem Yazici

  3. Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA

    George H. Thompson

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Grigoriou, E., Dormans, J.P. (2016). Pediatric Spine Trauma. In: Akbarnia, B., Yazici, M., Thompson, G. (eds) The Growing Spine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48284-1_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-48284-1_21

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-48283-4

  • Online ISBN: 978-3-662-48284-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation