Last updated January 6, 2022

Management of Pediatric Cervical Spine and Spinal Cord Injuries

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)
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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)
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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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Treatment

Thoracic elevation or an occipital recess is recommended in children, 8 years of age to prevent flexion of the head and neck when restrained supine on an otherwise flat backboard for better neutral alignment and immobilization of the cervical spine. (Level III)
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Closed reduction and halo immobilization are recommended for injuries of the C2 synchondrosis in children <7 years of age. (Level III)
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Reduction with manipulation or halter traction is recommended for patients with acute AARF (<4 weeks duration) that does not reduce spontaneously. Reduction with halter or tong/ halo traction is recommended for patients with chronic AARF (>4 weeks duration). (Level III)
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Internal fixation and fusion are recommended in patients with recurrent and/or irreducible AARF. (Level III)
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Consideration of primary operative therapy is recommended for isolated ligamentous injuries of the cervical spine and unstable or irreducible fractures or dislocations with associated deformity. (Level III)
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Operative therapy is recommended for cervical spine injuries that fail non-operative management. (Level III)
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Recommendation Grading

Overview

Title

Management of Pediatric Cervical Spine and Spinal Cord Injuries

Authoring Organization

Publication Month/Year

December 1, 2013

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this review is to address the unique aspects of children with real or potential cervical spinal injuries, and provide recommendations regarding their management

Target Patient Population

Children with potential cervical spinal injuries

Inclusion Criteria

Child

Health Care Settings

Ambulatory, Emergency care, Outpatient

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D010372 - Pediatrics, D013116 - Spinal Cord, D007103 - Immobilization, D011871 - Radiology, D013119 - Spinal Cord Injuries, D001268 - Atlanto-Axial Joint, D009809 - Odontoid Process

Keywords

spinal cord injury, pediatric, Radiology, immobilization

Source Citation

Neurosurgery, Volume 72, Issue suppl_3, March 2013, Pages 205–226, https://doi.org/10.1227/NEU.0b013e318277096c