Evaluation of the results of cervical spine and spinal Cord trauma in children

ABSTRACT

Major differences exist in the anatomy and biomechanics of the growing spine that causes failure patterns different from those in adults. Spinal injury in the pediatric patient is a main concern because timely diagnosis and appropriate treatment can prevent further neurologic damage and deformity and potentiate recovery. We conducted a retrospective clinical study of 137 cases [93 boys, 44 girls] of pediatric cervical spine injuries, managed over fifteen years, to present data from a large series of pediatric patients with cervical spine injuries from a single regional trauma center. The aim was to assess and analyze complications, etiology, pathogenesis, site of injuries and age difference of cervical spine and spinal cord injury in a pediatric age group and compare the findings with current literature. One hundred and thirty seven children with cervical spine injuries, seen over twelve years, were divided into two age groups 54 patients were in group one [0-9 years] and 83 patients were in group two [10-17 years]. We managed them according to status at presentation and type of injury. Forty seven patients were managed surgically and ninety nonsurgically [52 wore a halo brace and 38 wore different hard collars and braces]. T-test and Chi squares were used to analyze differences between groups. The most common cause of injury was motor vehicle accidents [MVA]. Our younger patients [Group 1] had sustained more neurological injuries than the older ones [Group 2], 77% vs. 48%; upper cervical spine was the most common site involved in 76%, while 43% suffered head injuries. In group two, 88% of children two sustained fractures or fracture/ subluxations; also in this group, subluxation, and fracture/ subluxation was present in 10 and 25% of children respectively. The most common radiological findings were vertebral fracutes [38%]. Solid fusions were demonstrated in all patients at late follow-up review [mean 6 years]. None of the children developed neurological deterioration; however 18% mortality was documented. Various fusion techniques were used and neurological and fusion outcomes improved as compared with the previous reports. Outcomes of cervical spine injuries in children are more positive than in adults, particularly in patients with incomplete injuries. The prognosis for children with complete spinal cord injuries, however, is still discouraging. Upper cervical spine injuries are more common between birth and 9 years of age; however fractures and fracture/subluxation are rare in this group. Surgical intervention with appropriate instrumentation and fusion are very effective in children with cervical spine instability