E2021. Pediatric Cervical Spine Trauma: What Every Radiologist Should Know
  1. Ashok Ramachandra; Children's Hospital Los Angeles
  2. Skorn Ponrartana; Children's Hospital Los Angeles
Traumatic injuries to the cervical spine of children represent less than two percent of pediatric trauma. However, when present, cervical spine injuries can be devastating. Because of anatomic, physiologic, and developmental differences between children and adults, the pattern of injuries can vary significantly between the two. The injury pattern also changes based on the age and development of a child. Furthermore, the common etiologies of injuries also change based on the age group. Since imaging plays a critical role in the management of pediatric cervical spine trauma, understanding the pediatric cervical spine is essential for any radiologist practicing in the emergency setting.

Educational Goals / Teaching Points
Anatomic, physiologic, and developmental differences between the cervical spine of kids and adults. Normal appearance of the pediatric cervical spine. How to interpret pediatric cervical spine imaging (Radiography, CT, MRI). Pitfalls and normal variants. Common injury patterns.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Kids have higher head to body ratios. In addition, kids have spinal hypermobility secondary to ligamentous laxity, developing/ossifying bones, and weak neck muscles. These differences lead to the pediatric fulcrum of motion being higher at C2-C3, while the adult fulcrum of motion is lower at C5-C6. This combination of factors create different injury patterns in kids. Typically, the younger the child, the injury will occur higher in the cervical spine. Furthermore, the younger the child, the more likely the injury is ligamentous and not bony. As the child gets older, the injury pattern becomes more adult-like. By age 10-12, the injury pattern is essentially adult-like. Injury patterns in young children include distraction injuries of the craniocervical junction and upper cervical spine, odontoid fractures, spinal cord injury without radiographic abnormality, and non-accidental trauma.

The physiologic and developmental changes of the pediatric cervical spine lead to varying patterns of injury depending on age and development. The injury pattern is typically adult-like by age 10-12. The younger the child, the injuries tend to be more ligamentous and higher in the cervical spine. Proper understanding of the injury patterns of the pediatric cervical spine can help ensure radiologists identify potentially serious injuries.