Management of Pediatric Cervical Spine and Spinal Cord Injuries

The available medical literature supports only 1 Level I recommendation for the management of pediatric patients with cervical spine or spinal cord injuries, specifically related to the diagnosis of patients with potential AOD. Level II and III diagnostic and level III treatment recommendations are supported by the remaining medical evidence. The literature suggests that obtaining neutral cervical spine alignment in a child may be difficult when standard backboards are used. The determination that a child does not have a cervical spine injury can be made on clinical grounds alone is supported by Class II and Class III medical evidence. When the child is alert and communicative and is without neurological deficit, neck tenderness, painful distracting injury, or intoxication, cervical radiographs are not necessary to exclude cervical spinal injury. When cervical spine radiographs are utilized to verify or rule out a cervical spinal injury in children , 9 years of age, only lateral and AP cervical spine views need be obtained. The traditional 3-view X-ray assessment may increase the sensitivity of plain spine radiographs in children 9 years of age and older. High resolution CT scan of the cervical spine provides more than adequate visualization of the cervical spine, but is not necessary in most children. CT and MRI are most appropriately used in selected cases to provide additional diagnostic information regarding a known or suspected injury (eg, CT for AOD) or to further assess the spine/spinal cord in an obtunded child. The vast majority of pediatric cervical spine injuries can be effectively treated non-operatively. The most effective immobilization appears to be accomplished with either halo devices or Minerva jackets. Halo immobilization is associated with acceptable but considerable minor morbidity in children, typically pin site infection and pin loosening. The only specific pediatric cervical spine injury for which medical evidence supports a particular treatment paradigm is an odontoid injury in children , 7 years of age. These children are effectively treated with closed reduction and immobilization. Primarily ligamentous injuries of the cervical spine in children may heal with external immobilization alone, but are associated with a relatively high rate of persistent or progressive deformity when treated non-operatively. Pharmacological therapy and intensive care unit management schemes for children with spinal cord injuries have not been described in the literature. © 2013 by the Congress of Neurological Surgeons.