Cervical injury (peds): Difference between revisions
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==Background== | ==Background== | ||
C-spine injury uncommon in children but large head in age <8 | C-spine injury uncommon in children but large head in age <8 creates system for upper cervical injury. Injuries most feared include atlanto-occipital dislocation(AOD) and atlantoaxial rotatory subluxation or fixation (AARF). Guidelines come from American Association of Neurological Surgeons and Congress of Neurological Surgeons in 2013. | ||
==Clinical Features== | ==Clinical Features== | ||
*Blunt trauma in pediatric population. | *Blunt trauma in pediatric population. | ||
*AARF- may occur spontaneously or in trauma- exam shows head rotated, tilted or unable to turn past midline | *AARF- may occur spontaneously or in trauma- exam shows head rotated, tilted or unable to turn past midline | ||
*AOD- can be devastating injury or even fatal | |||
==C-Spine Clearance Without Imaging== | ==C-Spine Clearance Without Imaging== | ||
| Line 22: | Line 23: | ||
#no unexplained hypotension | #no unexplained hypotension | ||
#not intoxicated | #not intoxicated | ||
#mechanism- | #mechanism-image if: MVC, fall >10 feet, non-accidental trauma known or suspected | ||
==SCIWORA== | ==SCIWORA== | ||
| Line 34: | Line 35: | ||
#AARF- C1-C2 motion analysis to characterize injury(3 position CT) | #AARF- C1-C2 motion analysis to characterize injury(3 position CT) | ||
#Plain films otherwise acceptable | #Plain films otherwise acceptable | ||
*SCIWORA- full spinal column | *SCIWORA- full spinal column radiographic imaging | ||
**MRI of suspected area of spinal damage | **MRI of suspected area of spinal damage | ||
**Assess spinal stability acutely and in follow-up with flex/ex films | **Assess spinal stability acutely and in follow-up with flex/ex films | ||
| Line 40: | Line 41: | ||
==Management== | ==Management== | ||
*Immobilization must account for relatively larger occiput using occipital recess or thoracic elevation to maintain c-spine neutrality. | *Immobilization must account for relatively larger occiput using occipital recess or thoracic elevation to maintain c-spine neutrality. | ||
*Neurosurgery consult for abnormalities | |||
==See Also== | ==See Also== | ||
*C-spine ( | *[[C-spine (NEXUS)]] | ||
==Sources== | ==Sources== | ||
*EB Medicine- EM Practice Guideline Update- Sept 2014- Updated Guidelines For Management Of Acute Cervical Spine And Spinal Cord Injury In Pediatric Patients | *EB Medicine- EM Practice Guideline Update- Sept 2014- Updated Guidelines For Management Of Acute Cervical Spine And Spinal Cord Injury In Pediatric Patients | ||
Revision as of 20:07, 8 September 2014
Background
C-spine injury uncommon in children but large head in age <8 creates system for upper cervical injury. Injuries most feared include atlanto-occipital dislocation(AOD) and atlantoaxial rotatory subluxation or fixation (AARF). Guidelines come from American Association of Neurological Surgeons and Congress of Neurological Surgeons in 2013.
Clinical Features
- Blunt trauma in pediatric population.
- AARF- may occur spontaneously or in trauma- exam shows head rotated, tilted or unable to turn past midline
- AOD- can be devastating injury or even fatal
C-Spine Clearance Without Imaging
- >3 years old
- alert
- no neurological deficit
- no midline cervical ttp
- no painful distracting injury
- no unexplained hypotension
- not intoxicated
- <3 years old
- GCS>13
- no neurological deficit
- no midline cervical ttp
- no painful distracting injury
- no unexplained hypotension
- not intoxicated
- mechanism-image if: MVC, fall >10 feet, non-accidental trauma known or suspected
SCIWORA
- Spinal cord injury without radiographic abnormality
- Exam findings of myelopathy without abnormalities on XR or CT
Workup
- No imaging if above criteria met based upon age.
- CT c-spine for concern of Atlanto-occipital dislocation(AOD) or atlantoaxial rotatory subluxation or fixation (AARF)
- AOD- CT to look for condyle-C1 interval (CCI)
- AARF- C1-C2 motion analysis to characterize injury(3 position CT)
- Plain films otherwise acceptable
- SCIWORA- full spinal column radiographic imaging
- MRI of suspected area of spinal damage
- Assess spinal stability acutely and in follow-up with flex/ex films
Management
- Immobilization must account for relatively larger occiput using occipital recess or thoracic elevation to maintain c-spine neutrality.
- Neurosurgery consult for abnormalities
See Also
Sources
- EB Medicine- EM Practice Guideline Update- Sept 2014- Updated Guidelines For Management Of Acute Cervical Spine And Spinal Cord Injury In Pediatric Patients