Even though it would seem logical, neuromuscular disorders typically do not affect the Cervical spine. Instead, neuromuscular disorders tend to result in thoracolumbar scoliosis. (7) Examples of these disorders include cerebral palsy, muscular dystrophy, spinal muscular Atrophy, and Rett's syndrome.
Cervical Spine Injury Distribution (Age/Location)
CSIs are less common in pediatric trauma patients than in adult patients. The NEXUS group found 30 injuries in 3065 (1%) pediatric patients, compared to injuries in 2.5% of adult patients (788/31,004). (8) Approximately two-thirds of pediatric CSI occur in patients older than 8 years of age. (9) These data reflect patients who arrived to emergency departments, and do not include those who died prior to transport. In a series of 102 patients, 42% of those younger than 10 years of age arrived neurologically intact, 42% had an incomplete spinal cord injury and 16% had a Complete Lesion. (10) Of those between 10 and 16 years, 41% (26 of 64 patients) arrived neurologically intact, 47% had partial spinal cord lesions, and 12% had complete spinal cord injury on arrival.
Types of injuries to the pediatric cervical spine include fractures, dislocations, or SCIWORA (Spinal Cord Injury Without Radiographic Abnormality). In one review of the National Pediatric Trauma Registry, 25-30% of all CSI were SCIWORA in children younger than 11 years. (11) In patients between 11 and 18 years, 15-20% of all CSI were SCIWORA. Fractures accounted for 35-40% of CSI in children younger than 7 years, 45-50% between 7 and 11 years, 60-70% from 12 to 16 years, and 70-75% in those older than 16 years. Dislocations caused 30-40% of the injuries in those younger than 7 years, 20-30% in those 7-11 years, and 15-25% in those 12-16 years. In summary, fractures are the most common injury seen and increase in frequency through childhood. Dislocations also are more common in younger children, but the difference between young and old is not as dramatic. SCIWORA is common in younger children, but may occur in any age group.
Younger children with CSI most commonly are injured in the upper cervical spine. (See Figure 2.) By the end of the teenage years, injuries are distributed more evenly between the upper and lower cervical spine. In children younger than 11 years of age, 15-20% of all CSI are below [C.sub.4]. In the ages 11-15, 35-40% of CSI are below [C.sub.4]. Upper and lower CSI are equally as likely in the child older than 15 years. (11) Series published through individual institutions have presented differing distribution of injuries, but one paper (11) included 408 children, the largest data set of pediatric CSI. (12-22)
[FIGURE 2 OMITTED]
Some data exist regarding the prevalence of CSI as an isolated injury. In a group of 72 children with CSI from Utah, one study notes that the median Glasgow Coma Score (GCS) was 15. (22) Fourteen percent of the children had a GCS less than 13. The mean injury severity score was 15, with a range of 4-54. (22) In another series, 37 children younger than 9 years had a mean injury severity score of 26, while the 36 children older than 8 years had a mean injury severity score of 12.1. (18) These data suggest that children may sustain an isolated CSI.
