Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts

被引:27
作者
Gopinathan, Nirmal Raj [1 ]
Viswanathan, Vibhu Krishnan [2 ]
Crawford, Alvin H. [3 ]
机构
[1] Postgrad Inst Med Educ & Res, Dept Orthoped Surg, Chandigarh, India
[2] Ohio State Univ, Wexner Med Ctr, Dept Neurol Surg, Columbus, OH 43202 USA
[3] Cincinnati Childrens Hosp, Dept Pediat Orthoped, Cincinnati, OH USA
关键词
Anatomical features; Clinical Decision Rules; pediatric cervical spine injuries; spinal cord injury without radiological anomaly; ATLANTOAXIAL ROTATORY SUBLUXATION; HELICAL COMPUTED-TOMOGRAPHY; CORD-INJURY; C-SPINE; YOUNG-CHILDREN; CLEARANCE PROTOCOL; PLAIN RADIOGRAPHS; PSEUDOSUBLUXATION; DISLOCATIONS; FRACTURES;
D O I
10.4103/ortho.IJOrtho_607_17
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
The clinical presentation and diagnostic workup in pediatric cervical spine injuries (CSI) are different from adults owing to the unique anatomy and relative immaturity. The current article reviews the existing literature regarding the uniqueness of these injuries and discusses the current guidelines of radiological evaluation. A PubMed search was conducted using keywords "paediatric cervical spine injuries" or "paediatric cervical spine trauma." Six hundred and ninety two articles were available in total. Three hundred and forty three articles were considered for the review after eliminating unrelated and duplicate articles. Further screening was performed and 67 articles (original articles and review articles only) related to pediatric CSI were finally included. All articles were reviewed for details regarding epidemiology, injury patterns, anatomic considerations, clinical, and radiological evaluation protocols. CSIs are the most common level (60%-80%) for pediatric Spinal Injuries (SI). Children suffer from atlantoaxial injuries 2.5 times more often than adults. Children's unique anatomical features (large head size and highly flexible spine) predispose them to such a peculiar presentation. The role of National Emergency X-Ray Utilization Study, United State (NEXUS) and Canadian Cervical Spine Rule criteria in excluding pediatric cervical injury is questionable but cannot be ruled out completely. The minimum radiological examination includes 2- or 3-view cervical X-rays (anteroposterior, lateral +/- open-mouth odontoid views). Additional radiological evaluations, including computerized tomography (CT) and magnetic resonance imaging (MRI) are obtained in situations of abnormal physical examination, abnormal X-rays, inability to obtain adequate X-rays, or to assess cord/soft-tissue status. The clinical criteria for cervical spine injury clearance can generally be applied to children older than 2 years of age. Nevertheless, adequate caution should be exercised before applying these rules in younger children. Initial radiographic investigation should be always adequate plain radiographs of cervical spine. CT and MRI scans should only be performed in an appropriate group of pediatric patients.
引用
收藏
页码:489 / 500
页数:12
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