Management of Pediatric Cervical Spine and Spinal Cord Injuries
Publication Date: December 1, 2013
Last Updated: March 14, 2022
RECOMMENDATIONS
Diagnostic
Computed tomographic (CT) imaging to determine the condyle-C1 interval (CCI)for pediatric patients with potential atlanto-occipital dislocation (AOD) is recommended. (Level I)
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Cervical spine imaging is not recommended in children who are >3 years of age and who have experienced trauma and who: • are alert
• have no neurological deficit
• have no midline cervical tenderness
• have no painful distracting injury
• do not have unexplained hypotension
• and are not intoxicated. (Level II)
• have no neurological deficit
• have no midline cervical tenderness
• have no painful distracting injury
• do not have unexplained hypotension
• and are not intoxicated. (Level II)
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Cervical spine imaging is not recommended in children who are <3 years of age who have experienced trauma and who:
• have a Glasgow Coma Scale (GCS) >13
• have no neurological deficit
• have no midline cervical tenderness
• have no painful distracting injury
• are not intoxicated
• do not have unexplained hypotension and
• do not have motor vehicle collision (MVC), a fall from a height >10 feet, or non-accidental trauma (NAT) as a known or suspected mechanism of injury. (Level II)
• have a Glasgow Coma Scale (GCS) >13
• have no neurological deficit
• have no midline cervical tenderness
• have no painful distracting injury
• are not intoxicated
• do not have unexplained hypotension and
• do not have motor vehicle collision (MVC), a fall from a height >10 feet, or non-accidental trauma (NAT) as a known or suspected mechanism of injury. (Level II)
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Cervical spine radiographs or high resolution CT is recommended for children who have experienced trauma and who do not meet either set of criteria above. (Level II)
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Three-position CT with C1-C2 motion analysis to confirm and classify the diagnosis is recommended for children suspected of having atlantoaxial rotatory fixation (AARF). (Level II)
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Anteroposterior (AP) and lateral cervical spine radiography or high-resolution CT is recommended to assess the cervical spine in children <9 years of age. (Level III)
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AP, lateral, and open-mouth cervical spine radiography or high-resolution CT is recommended to assess the cervical spine in children 9 years of age and older. (Level III)
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High resolution CT scan with attention to the suspected level of neurological injury is recommended to exclude occult fractures or to evaluate regions not adequately visualized on plain radiographs. (Level III)
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Flexion and extension cervical radiographs or fluoroscopy are recommended to exclude gross ligamentous instability when there remains a suspicion of cervical spinal instability following static radiographs or CT scan. (Level III)
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Magnetic resonance imaging (MRI) of the cervical spine is recommended to exclude spinal cord or nerve root compression, evaluate ligamentous integrity, or provide information regarding neurological prognosis. (Level III)
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Overview
Title
Management of Pediatric Cervical Spine and Spinal Cord Injuries
Authoring Organization
Congress of Neurological Surgeons