Although Cervical spine injuries (CSIs) are uncommon in children, a missed or delayed diagnosis may have devastating consequences for the patient. A thorough understanding of normal pediatric anatomy, injury patterns, and children who are at increased risk for injury is critical for the physician caring for the acutely injured child. The author provides an overview of the unique features of the pediatric spine, and fracture patterns that occur commonly in children. The author also offers guidelines on instances when a child is at increased risk for sustaining a CSI.

--The Editor

Introduction

The diagnoses of CSIs in children deserves special attention and distinction from injuries in adults. The anatomy, biomechanics, and injury pattern of the infant are different than those of the school-age child and the adolescent. By adolescence, the cervical spine has assumed the same mechanical response as the adult spinal column. This review will describe the anatomy of the cervical spine from infancy through adolescence and discuss the varying injury patterns that may occur through childhood. A general sense of the biomechanical tolerance of the pediatric spine will be developed through a review of injury-producing impacts. Additionally, limitations of data will be acknowledged that will necessitate practical management recommendations.

Anatomy of the Cervical Spine

The cervical spine is composed of seven Vertebrae, each separated by an intervertebral disc. The cranium rests upon the atlas ([C.sub.1]) while [C.sub.7] rests upon the first Thoracic vertebra ([T.sub.1]. See Figure 1 for the landmarks of the lower cervical vertebrae.

[FIGURE 1 OMITTED]

Tethering ligaments and their associated attachments are listed in Table 1. The transverse ligament is unique to [C.sub.1] and maintains the relationship between [C.sub.1] and [C.sub.2]. This ligament attaches to the Posterior dens (odontoid process of [C.sub.2]) from the inner, lateral aspect of [C.sub.1]. The other tethering ligaments, as well as the facets and interfacet joints, limit horizontal motion between the vertebral bodies. Additionally, the tethering ligaments limit axial, or vertical, elongation of the spinal column. When the mechanical properties of these structures are overcome by the forced neck motion of impact, an injury will result.

Developmental Biology of the Cervical Spine

The ossification centers of the vertebral bodies appear during the second month of gestation as sclerodermal mesoderm migrates and thickens into the vertebral column. The vertebral bodies are formed by two lateral neural arches and a centra. The centra and the Anterior portion of the lateral arches fuse to form the vertebral body. The posterior portions of the neural arches fuse to form the transverse processes, facets, and spinous process. The anterior and posterior arches are radiographically evident at birth, while the spinous, articular, and transverse processes do not fuse until approximately 8 years of age.