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Pediatric Cervical Spine Cheat Sheet: A Case Study

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Pediatric Cervical Spine Cheat Sheet : A Comprehensive Approach
< 8 y/o – falls, mostly upper cervical spine injuries (occiput – C4)
> 8 y/o – sports related, mostly lower cervical spine injuries Other causes: birth trauma, MV related accidents, firearms, electrical shock, child abuse
Bone fractures, subluxations, dislocations, and SCIWORA.
Bilateral Facets Dislocation – unstable ; spinal cord injury
Unilateral Facet Dislocation – stable; nerve root injury
Altered vital signs, pain, scalp laceration, facial/upper body injury, torticollis, focal midline tenderness, numbness, stiffness, ROM limitation < 45 degrees, paresthesia, weakness, abnormal sensation/sensory loss, …show more content…

abrasions, edema, ecchymosis)
NEXUS
Radiographs – all cervical vertebrae and T1; AP view open mouth and lower c-spine, lateral, R & L oblique
CT – recommended in acute trauma cases, congenital developmental abnormalities, tumors; limited use since many c-spine pediatric injuries are ligamentous in nature
MRI - recommended due to persistent neurological deficits, soft tissue involvement, ligamentous & disc injuries, spinal cord hemorrhage, SCIWORA Also prescribed when radiographs are clear BUT child is unconscious and/or intubated.
A-P odontoid/open mouth view: in supine, shows articulation of C1-C2 : width of lateral masses should be = , none or very minimal overhanging of atlas, dens symmetrically between lateral masses of atlas, C2 spinous process in midline
A-P lower cervical view: in supine, shows 5 lower c- vertebrae, upper thoracic vertebrae with ribs, clavicles and trachea : c & t vertebral bodies are vertically aligned, spinous processes are in midline, illusion of bone L column on each side of vertebral bodies; transverse processes within image of L column, pedicles - radiodense oval – like cortical outline, interpendicular distance = …show more content…

borders of vertebral bodies, line # 2, post. borders of vertebral bodies, line # 3 spinolaminar, vertebral bodies have box-like appearance, intervertebral spaces are well preserved, articular pillars and facets joints - a pair at each level, bursa between dens & facet on atlas - dark radiolucent line ant.to dens, distance kept by transverse ligament at atlas during neck ROM is 4.5mm, transverse processes superimposed over vertebral bodies, 6mm between post. pharyngeal & AI aspect of C2, 14mm between post. wall of trachea and AI aspect of

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