Pediatric Cervical Spine Injury: A Three-Year Experience

BACKGROUND Traumatic injuries of the cervical spine are uncommon in pediatrics. Children less than 8 years of age are reported to have "exclusively" upper cervical injuries. Recent experience at the Children's Hospital of Alabama (TCHA) challenged both of these notions. METHODS A concurrent retrospective chart review of all cervical spine injuries treated at TCHA between January 1, 1992 and December 31, 1994 was performed. Data collected included patient demographics, date and time of injury, mechanism and site of injury, presence of associated injuries, clinical management, and outcome. RESULTS Thirty-four patients with cervical spine injuries were seen at TCHA in the 36-month study period. The leading mechanism of injury was motor vehicle crashes (23/34 or 68%). Head injuries were associated with cervical spine injury in 53% of patients. Of the 20 patients aged 8 years or less, 10 (50%) had "low" cervical spine injuries (below C4). Overall mortality was 41% (14/34). Of the 15 vehicle occupants, 12 were unrestrained or inappropriately restrained. Two of those appropriately restrained were young school-aged children in lap-shoulder belts who sustained isolated cervical spine injuries. CONCLUSIONS 1. The number of pediatric cervical spine injuries in our institution appears to be increasing. 2. Cervical spine injury in children less than 8 years of age are not exclusively confined to the region above C4. 3. Occurrence of cervical spine injuries despite lap-shoulder belt use suggests that efforts should be focused on refinement of motor vehicle restraint devices in young school-aged children.