Cervical injury (peds): Difference between revisions
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==Background== | ==Background== | ||
C-spine injury uncommon in children but large head in age <8 creates system for upper cervical injury | *C-spine injury uncommon in children but large head in age <8 creates system for upper cervical injury | ||
*Injuries most feared include [[atlanto-occipital dissociation]] and atlantoaxial rotatory subluxation or fixation (AARF). | |||
==Clinical Features== | ==Clinical Features== | ||
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*AOD- can be devastating injury or even fatal | *AOD- can be devastating injury or even fatal | ||
==C-Spine Clearance Without Imaging== | ==Differential Diagnosis== | ||
===>3 years old=== | {{Cervical spine injuries}} | ||
==Diagnosis== | |||
===C-Spine Clearance Without Imaging=== | |||
====>3 years old==== | |||
*alert | *alert | ||
*no neurological deficit | *no neurological deficit | ||
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*not intoxicated | *not intoxicated | ||
===<3 years old=== | ====<3 years old==== | ||
*[[GCS (Peds)|GCS]]>13 | *[[GCS (Peds)|GCS]]>13 | ||
*no neurological deficit | *no neurological deficit | ||
Revision as of 13:50, 19 December 2015
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 dissociation and atlantoaxial rotatory subluxation or fixation (AARF).
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
Differential Diagnosis
Vertebral fractures and dislocations types
- Cervical fractures and dislocations
- Thoracic and lumbar fractures and dislocations
Diagnosis
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
Diagnosis
- 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
General/Adult
Pediatric
- C-spine (peds)
- Abuse (Nonaccidental Trauma)
- GCS (Peds)
- EBQ:PECARN Pediatric Head CT Rule
- Differential diagnosis documentation#Head Trauma
References
- EB Medicine- EM Practice Guideline Update- Sept 2014- Updated Guidelines For Management Of Acute Cervical Spine And Spinal Cord Injury In Pediatric Patients
- American Association of Neurological Surgeons and Congress of Neurological Surgeons in 2013.