Pediatric subaxial cervical spine injuries

origins, management, and outcome in 51 patients.

Seref Dogan, Sam Safavi-Abbasi, Nicholas Theodore, Eric Horn, Harold L. Rekate, Volker K H Sonntag

Research output: Contribution to journalArticle

Abstract

OBJECT: In this study the authors evaluated the mechanisms and patterns of injury and the factors affecting management and outcome of pediatric subaxial cervical spine injuries (C3-7). METHODS: Fifty-one pediatric patients (38 boys and 13 girls; mean age 12.4 years, range 10 months-16 years) with subaxial cervical spine injuries were reviewed retrospectively. Motor vehicle accidents (MVAs) were the most common cause of injury. Overall, 12% presented with a dislocation, 63% with a fracture, 19% with a fracture-dislocation, and 6% with a ligamentous injury. The most frequently injured level was C6-7 (33%); C3-4 (6%) was least frequently involved. Sixty-four percent of patients were neurologically intact, 16% had incomplete spinal cord injuries (SCIs), 14% had complete SCIs, and three patients (6%) died after admission and before assessment. Treatment was conservative in 64%: seven (13%) wore a halo vest and 26 (51%) wore a rigid cervical orthosis. Surgery was performed in the other 18 patients (36%), with the breakdown as follows: 15 (30%) underwent an anterior approach, two (4%) had posterior approaches, and one (2%) had a combined approach. Postoperatively, four patients (8% who had a neurological deficit improved. The overall mortality rate was 8%; all deaths were related to MVAs. There were no surgery-related deaths or complications. CONCLUSIONS: Subaxial cervical spine injuries are common in children 9 to 16 years of age, and occur principally between C-5 and C-7. Multilevel injury is more common in children 8 years of age and older than in younger children and infants. Most patients with subaxial cervical spine injuries can be treated conservatively. Both anterior and posterior approaches are safe and effective.

Original languageEnglish (US)
JournalNeurosurgical Focus
Volume20
Issue number2
StatePublished - 2006
Externally publishedYes

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Spine
Pediatrics
Wounds and Injuries
Motor Vehicles
Spinal Cord Injuries
Accidents
Orthotic Devices
Mortality

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Dogan, S., Safavi-Abbasi, S., Theodore, N., Horn, E., Rekate, H. L., & Sonntag, V. K. H. (2006). Pediatric subaxial cervical spine injuries: origins, management, and outcome in 51 patients. Neurosurgical Focus, 20(2).

Pediatric subaxial cervical spine injuries : origins, management, and outcome in 51 patients. / Dogan, Seref; Safavi-Abbasi, Sam; Theodore, Nicholas; Horn, Eric; Rekate, Harold L.; Sonntag, Volker K H.

In: Neurosurgical Focus, Vol. 20, No. 2, 2006.

Research output: Contribution to journalArticle

Dogan, S, Safavi-Abbasi, S, Theodore, N, Horn, E, Rekate, HL & Sonntag, VKH 2006, 'Pediatric subaxial cervical spine injuries: origins, management, and outcome in 51 patients.', Neurosurgical Focus, vol. 20, no. 2.
Dogan, Seref ; Safavi-Abbasi, Sam ; Theodore, Nicholas ; Horn, Eric ; Rekate, Harold L. ; Sonntag, Volker K H. / Pediatric subaxial cervical spine injuries : origins, management, and outcome in 51 patients. In: Neurosurgical Focus. 2006 ; Vol. 20, No. 2.
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AB - OBJECT: In this study the authors evaluated the mechanisms and patterns of injury and the factors affecting management and outcome of pediatric subaxial cervical spine injuries (C3-7). METHODS: Fifty-one pediatric patients (38 boys and 13 girls; mean age 12.4 years, range 10 months-16 years) with subaxial cervical spine injuries were reviewed retrospectively. Motor vehicle accidents (MVAs) were the most common cause of injury. Overall, 12% presented with a dislocation, 63% with a fracture, 19% with a fracture-dislocation, and 6% with a ligamentous injury. The most frequently injured level was C6-7 (33%); C3-4 (6%) was least frequently involved. Sixty-four percent of patients were neurologically intact, 16% had incomplete spinal cord injuries (SCIs), 14% had complete SCIs, and three patients (6%) died after admission and before assessment. Treatment was conservative in 64%: seven (13%) wore a halo vest and 26 (51%) wore a rigid cervical orthosis. Surgery was performed in the other 18 patients (36%), with the breakdown as follows: 15 (30%) underwent an anterior approach, two (4%) had posterior approaches, and one (2%) had a combined approach. Postoperatively, four patients (8% who had a neurological deficit improved. The overall mortality rate was 8%; all deaths were related to MVAs. There were no surgery-related deaths or complications. CONCLUSIONS: Subaxial cervical spine injuries are common in children 9 to 16 years of age, and occur principally between C-5 and C-7. Multilevel injury is more common in children 8 years of age and older than in younger children and infants. Most patients with subaxial cervical spine injuries can be treated conservatively. Both anterior and posterior approaches are safe and effective.

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