title: Pediatric subaxial cervical spine injuries: origins, management, and outcome in 51 patients.
abstract: OBJECTIVE
  In this study the authors evaluated the mechanisms and patterns of injury and the factors affecting management and outcome of pediatric subaxial cervical spine injuries (C3-7).
  
  
  METHODS
  Fifty-one pediatric patients (38 boys and 13 girls; mean age 12.4 years, range 10 months-16 years) with subaxial cervical spine injuries were reviewed retrospectively. Motor vehicle accidents (MVAs) were the most common cause of injury. Overall, 12% presented with a dislocation, 63% with a fracture, 19% with a fracture-dislocation, and 6% with a ligamentous injury. The most frequently injured level was C6-7 (33%); C3-4 (6%) was least frequently involved. Sixty-four percent of patients were neurologically intact, 16% had incomplete spinal cord injuries (SCIs), 14% had complete SCIs, and three patients (6%) died after admission and before assessment. Treatment was conservative in 64%: seven (13%) wore a halo vest and 26 (51%) wore a rigid cervical orthosis. Surgery was performed in the other 18 patients (36%), with the breakdown as follows: 15 (30%) underwent an anterior approach, two (4%) had posterior approaches, and one (2%) had a combined approach. Postoperatively, four patients (8% who had a neurological deficit improved. The overall mortality rate was 8%; all deaths were related to MVAs. There were no surgery-related deaths or complications.
  
  
  CONCLUSIONS
  Subaxial cervical spine injuries are common in children 9 to 16 years of age, and occur principally between C-5 and C-7. Multilevel injury is more common in children 8 years of age and older than in younger children and infants. Most patients with subaxial cervical spine injuries can be treated conservatively. Both anterior and posterior approaches are safe and effective.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Seref
authors.initials: S
authors.lastname: Dogan
authors.forename: Sam
authors.initials: S
authors.lastname: Safavi-Abbasi
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
authors.forename: Eric
authors.initials: E
authors.lastname: Horn
authors.forename: Harold L
authors.initials: HL
authors.lastname: Rekate
authors.forename: Volker K H
authors.initials: VK
authors.lastname: Sonntag
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D004204:Joint Dislocations / Q000209:etiology / Q000628:therapy; D017846:Longitudinal Ligaments / Q000293:injuries; D008279:Magnetic Resonance Imaging; D008297:Male; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014143:Traction; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery / Q000628:therapy*