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Cervical spine injuries

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Only 1% or 2% of children admitted to hospital after trauma have cervical spine injuries but the consequences can be enormous. Records from the Children's Hospital in Cincinnati, Ohio have been analysed (


Over a period of 9½12 years (1991–2000) 103 children were admitted with cervical spine injuries. The peak age of injury was 14 years. Over half of the injuries (52%) were sustained in traffic accidents and, in these, 59% of the victims were passengers. Other mechanisms of injury included sports injuries (27%), falls (15%), and child abuse (3%). Most injuries (68%) were high cervical (C1 to C4). Thirty-eight per cent of the children had spinal cord injury without radiographic abnormality (SCIWORA—another one for AAC (Archivist's Acronym Collection)). Head injuries also occurred in 38% of patients. Nineteen children died, of whom 18 had been injured in a motor vehicle accident (the other death was from child abuse). The risk of death was greatest in younger children, those with upper cervical spine injuries, and those with associated head injury. Three quarters of the children with sports injuries and all of those suffering from child abuse had SCIWORA.

In younger children motor accidents were the predominant cause and sports injuries affected mainly older boys. Cervical spine fractures most commonly resulted from falls or dives, cervical spine dislocations from motor vehicle related trauma (especially to pedestrians), and SCIWORA from sports injuries and child abuse. Five patients had complete spinal cord lesions, all of them with low (C4–C7) lesions. Four of these had motor vehicle related injuries and all four died.

Cervical spine injuries in children are uncommon but potentially disastrous. Cord injury may occur without radiographic abnormality, especially with sports injuries or child abuse.

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