Cervical spine injuries in pediatric athletes: mechanisms and management

✓Sports-related injuries to the spine, although relatively rare compared with head injuries, contribute to significant morbidity and mortality in children. The reported incidence of traumatic cervical spine injury in pediatric athletes varies, and most studies are limited because of the low prevalence of injury. The anatomical and biomechanical differences between the immature spine of pediatric patients and the mature spine of adults that make pediatric patients more susceptible to injury include a greater mobility of the spine due to ligamentous laxity, shallow angulations of facet joints, immature development of neck musculature, and incomplete ossification of the vertebrae. As a result of these differences, 60 to 80% of all pediatric vertebral injuries occur in the cervical region. Understanding pediatric injury biomechanics in the cervical spine is important to the neurosurgeon, because coaches, parents, and athletes who place themselves in positions known to be associated with spinal cord injury (SCI) run a higher risk of such injury and paralysis. The mechanisms of SCI can be broadly subclassified into five types: axial loading, dislocation, lateral bending, rotation, and hyperflexion/hyperextension, although severe injuries often result from a combination of more than one of these subtypes. The aim of this review was to detail the characteristics and management of pediatric cervical spine injury.

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Neck Injury

Pediatrics in Review ◽

10.1542/pir.16.1.28 ◽

1995 ◽

Vol 16 (1) ◽

pp. 28-28

Author(s):

Jeffrey R. Avner

Keyword(s):

At Risk ◽

Cervical Spine ◽

Cervical Spine Injury ◽

Pediatric Patients ◽

Neck Injury ◽

Spine Injury ◽

Clinical Markers ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Spine Radiographs

Although rare in pediatrics, cervical spine injuries still are associated with serious morbidity, disability, and mortality. Many of these injuries are exacerbated by inadequate neck immobilization or improper manipulation. Thus, the physician should be aware of which children are at risk for cervical spine injury and how to assess these patients properly. To find clinical markers that identify children who actually have cervical spine injuries, Rachesky et al reviewed 2133 cervical spine radiographs obtained in pediatric patients during a 7-year period. Of these children, 25 (1.2%) had abnormalities confirmed on radiographs. The incidence of injury increased with age; only four of the children who had cervical spine injuries were less than 8 years old.

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Fatal Cervical Spine Injury Following a Bicycle Crash

Scandinavian Journal of Forensic Science ◽

10.1515/sjfs-2017-0002 ◽

2017 ◽

Vol 23 (1) ◽

pp. 3-6

Author(s):

Lars Uhrenholt ◽

Lene Warner Thorup Boel ◽

Asser Hedegaard Thomsen

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Spinal Injury ◽

Head Injuries ◽

Spine Injury ◽

Protective Effects ◽

Safety Measures ◽

Cervical Spine Injuries ◽

Bicycle Helmets ◽

Mandatory Use

Abstract Spinal injury following direct loading of the head and neck is a rare sequel of bicycle crashes. Fatal head injuries following bicycle crashes have been described in great detail and safety measures such as bicycle helmets have been developed accordingly. Less frequently, however, potentially severe cervical spine injuries have been described. We present the case of a middle-aged female who sustained an ultimately fatal cervical spine injury following a collision with a car whilst biking wearing a helmet. We discuss the literature regarding the protective effects of bicycle helmets, the relevance to cervical spine injury and legislation on mandatory use of helmets for injury prevention.

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Operative Treatment of Severe Cervical Spine Injuries Sustained in Youth Sports: Experience from a Pediatric Level 1 Trauma Center over a 16-Year Period

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00085 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0008

Author(s):

Bram P Verhofste ◽

Daniel J Hedequist ◽

Craig M Birch ◽

Emily S Rademacher ◽

Michael P Glotzbecker ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Trauma Center ◽

Youth Sports ◽

Axial Loading ◽

Permanent Disability ◽

Cervical Spine Injuries ◽

Cord Injury ◽

Spine Injuries ◽

Level 1

Background: Sports-related cervical spine injuries (CSI) are devastating traumas with the potential for permanent disability. There is a paucity of literature on operative CSI sustained in youth athletes. Hypothesis/Purpose: The aims of this study aims were to review injury characteristics, surgical treatment, and outcomes of severe pediatric CSI encountered in youth sports. Methods: We reviewed children less than 18 years old with operative sports-related CSI at a pediatric Level 1 pediatric trauma center between 2004−2019. All cases underwent modern cervical spine instrumentation and fusion. SCI were stratified according to the American Spinal Injury Association Impairment Scale (ASIA). Clinical, radiographic, and surgical characteristics were compared between groups of patients with and without spinal cord injury (SCI). Results: Three thousand two hundred and thirty-one children (mean, 11.3y±4.6y) were evaluated for CSI at our institution during the 16-year period. The majority of traumas resulted from sports/recreational activities and were seen in 1365 cases (42.3%). Of these, 171/1365 patients (12.5%) were admitted and 29/1365 patients (2.1%) required surgical intervention (mean age, 14.5y±2.88y; range, 6.4y–17.8y). Sports included: eight football (28%), seven wrestling (24%), five gymnastics (17%), four diving (14%), two trampoline (7%), one hockey (3%), one snowboarding (3%), and one biking injury (3%). Mechanisms were 19 hyperflexion (65%), eight axial loading (28%), and two hyperextension injuries (7%). The majority of operative CSI were fractures (79%) and/or subaxial defects (72%). Seven patients (30%) sustained SCI and three patients (10%) spinal cord contusion or myelomalacia without neurologic deficits. The risk of SCI increased with age (15.8y vs. 14.4y; p=0.03) and axial loading mechanism (71% vs. 14%; p=0.003). Postoperatively, two SCI patients (29%) improved 1 ASIA Grade and one (14%) improved 2 ASIA Grades. Increased complications developed in SCI than patients without SCI (mean, 2.0 vs 0.1 complications; p=0.02). Clinical and radiographic fusion occurred in 24/26 patients (92%) with adequate follow-up (median, 32 months). Ten patients returned to their previous activity and nine to sports with a lower level of activity. Conclusion: The overall incidence of sports-related operative CSI is low. Age- and gender discrepancies exist, with male adolescent athletes most commonly requiring surgery. Hyperflexion injuries had a good prognosis; however, older males with axial loading CSI sustained in contact sports were at greatest risk of SCI, complications, and permanent disability. [Figure: see text][Table: see text][Table: see text]

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Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

CJEM ◽

10.2310/8000.2013.130978 ◽

2014 ◽

Vol 16 (02) ◽

pp. 131-135 ◽

Cited By ~ 3

Author(s):

Hendrik P. Van Zyl ◽

James Bilbey ◽

Alan Vukusic ◽

Todd Ring ◽

Jennifer Oakes ◽

...

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Clinical Skills ◽

Ct Scans ◽

Spine Injury ◽

Emergency Physicians ◽

Cervical Spine Injuries ◽

Spine Ct ◽

Spine Injuries ◽

Rule Out

ABSTRACT Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.

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Association of Head Trauma with Cervical Spine Injury, Spinal Cord Injury, or Both

The Journal of Trauma: Injury, Infection, and Critical Care ◽

10.1097/00005373-199903000-00018 ◽

1999 ◽

Vol 46 (3) ◽

pp. 450-452 ◽

Cited By ~ 64

Author(s):

Hideo Iida ◽

Shigekuni Tachibana ◽

Takao Kitahara ◽

Shigeharu Horiike ◽

Takashi Ohwada ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spine ◽

Head Trauma ◽

Cervical Spine Injury ◽

Spine Injury ◽

Cord Injury

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Halo-thoracic brace immobilization in 188 patients with acute cervical spine injuries

Journal of Neurosurgery ◽

10.3171/jns.1983.58.4.0508 ◽

1983 ◽

Vol 58 (4) ◽

pp. 508-515 ◽

Cited By ~ 49

Author(s):

Richard C. Chan ◽

Joseph F. Schweigel ◽

Gordon B. Thompson

Keyword(s):

Cervical Spine ◽

Early Mobilization ◽

Fusion Rate ◽

Spine Injury ◽

Cervical Cord ◽

Content Type ◽

Cervical Spine Injuries ◽

Cervical Fractures ◽

Cord Injury ◽

Skull Traction

✓ The authors report 188 patients with acute cervical spine injury with fracture who underwent Halothoracic brace immobilization. The majority of the fractures were considered unstable. Early neurological assessment revealed 24 patients without neurological deficit. There were 164 patients with associated cervical cord injury; 84 patients with incomplete, and 80 patients with complete tetraplegia. Management consisted of skull traction and application of the Halo-thoracic brace about 1.3 weeks after admission. The average radiological union time was 11.5 weeks following a mean of 10.2 weeks of immobilization in a Halo apparatus. Satisfactory restoration of bone and ligament stability, with no significant posttreatment neck pain, was obtained in 168 cases (89%). This is comparable to the fusion rate achieved for cervical fractures in the literature. The follow-up periods range from 1 month to 6 years, with a mean of 10.8 months. The management and results in 73 patients with unilaterally and bilaterally locked facets with or without fractures are discussed. Complete tetraplegia is not considered a contraindication to Halo apparatus immobilization. The multiple factors responsible for overcoming the barrier of anesthetic skin are elucidated. Use of the Halo apparatus offers early mobilization and rehabilitation without neurological deterioration. Complications are few and insignificant.

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A Nearly Lethal Screw: An Unusual Cause of Recurrent Bradycardia and Asystole Episodes after Fixation of the Cervical Spine

Case Reports in Critical Care ◽

10.1155/2017/3748930 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Amit Frenkel ◽

Yair Binyamin ◽

Evgeni Brotfain ◽

Leonid Koyfman ◽

Aviel Roy-Shapira ◽

...

Keyword(s):

Cervical Spine ◽

Spine Injury ◽

Cervical Cord ◽

Unstable Fracture ◽

Cervical Spine Injuries ◽

Cord Injury ◽

Fixation Screw ◽

Direct Pressure ◽

History Of ◽

High Cervical

We present a case of a 51-year-old man who was injured in a bicycle accident. His main injury was an unstable fracture of the cervical and thoracic vertebral column. Several hours after his arrival to the hospital the patient underwent open reduction and internal fixation (ORIF) of the cervical and thoracic spine. The patient was hospitalized in our critical care unit for 99 days. During this time patient had several episodes of severe bradycardia and asystole; some were short with spontaneous return to sinus and some required pharmacological treatment and even Cardiopulmonary Resuscitation (CPR). Initially, these episodes were attributed to the high cervical spine injury, but, later on, CT scan suggested that a fixation screw abutted on the esophagus and activated the vagus nerve by direct pressure. After repositioning of the cervical fixation, the bradycardia and asystole episodes were no longer observed and the patient was released to a rehabilitation ward. This case is presented in order to alert practitioners to the possibility that, after operative fixation of cervical spine injuries, recurrent episodes of bradyarrhythmia can be caused by incorrect placement of the fixation screws and might be confused with the natural history of the high cervical cord injury.

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Regional injuries of the cervical spine: sports-related anatomical, pathophysiological, and clinical perspectives

10.1093/med/9780199533909.003.0023 ◽

2013 ◽

Author(s):

Ezequiel Gherscovici ◽

Eli Baron ◽

Alexander Vaccaro

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Motor Vehicle ◽

Spinal Column ◽

Neurological Injury ◽

Spine Injury ◽

Sporting Events ◽

Cervical Spine Injuries ◽

Cord Injury ◽

Athletic Field

Cervical spine injuries occur infrequently on the athletic field (Dietz and Lillegard 1999). Nevertheless, sporting events have been reported as the fourth most common cause of spinal cord injury (behind motor vehicle collisions, assaults, and falls) (NSCISC 2006). The possibility of catastrophic cervical spine injury exists with involvement in sports, where it can be defined as ‘structural distortion of the cervical spinal column associated with actual or potential damage to the spinal cord’. This may result in irreversible neurological injury to the athlete (...

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Detection of Cervical Spine Injuries in Alert, Asymptomatic Geriatric Blunt Trauma Patients: Who Benefits from Radiologic Imaging?

The American Surgeon ◽

10.1177/000313480607200903 ◽

2006 ◽

Vol 72 (9) ◽

pp. 773-777 ◽

Cited By ~ 1

Author(s):

Adrian W. Ong ◽

Aurelio Rodriguez ◽

Robert Kelly ◽

Vicente Cortes ◽

Jack Protetch ◽

...

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Blunt Trauma ◽

Cervical Spine Injury ◽

Motor Vehicle ◽

Spine Injury ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Anatomic Locations

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 ± 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.

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Acute traumatic unilateral cervical C4–C5 facet dislocation in pediatric toddlers

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3019-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Wongthawat Liawrungrueang ◽

Rattanaporn Chamnan ◽

Weera Chaiyamongkol ◽

Piyawat Bintachitt

Keyword(s):

Cervical Spine ◽

Neurological Deficit ◽

Closed Reduction ◽

Motor Vehicle ◽

Rehabilitation Program ◽

Spine Injury ◽

Neck Muscle ◽

Cervical Spine Injuries ◽

Facet Dislocation ◽

Cord Injury

Abstract Background The present study is to highlight the challenges in managing cervical spine injuries in toddlers (less than 4 years of age) without neurological deficit. Cases of unilateral cervical C4–C5 facet dislocation in toddlers are very rare. Case presentation A 3-year-old girl suffered cervical spine injury after a motor vehicle collision with unilateral C4–C5 facet dislocation without neurological deficit. Magnetic resonance imaging (MRI) showed no spinal cord injury, Frankel grade E. Initial management was cervical spine protection. Definite treatment and complication were discussed with the patient’s parents before closed reduction maneuver with minerva cast was applied under sedation. The patient showed no complication after closed reduction and the cervical spine had aligned well in radiographs. The minerva cast was removed at 8 weeks, at which point neck muscle stretching rehabilitation program started. At one-year follow up, the child was asymptomatic, had full active cervical motion and good function. In radiographs, the cervical spine had normal alignment and was healed. Conclusions Unilateral cervical facet dislocation in toddlers is very rare. Closed reduction maneuver and the minerva cast applied were optional in this case. The parents were highly satisfied with the effective treatment and outcome.

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