Cervical spine injuries in children, part II: management and special considerations.
BACKGROUND
The diagnosis and management of cervical spine injury is more complex in children than in adults.


OBJECTIVE
Part I of this series stressed the importance of tailoring the evaluation of cervical spine injuries based on age, mechanism of injury, and physical examination findings. Part II will discuss the role of magnetic resonance imaging (MRI) as well as the management of pediatric cervical spine injuries in the emergency department.


CONCLUSIONS
Children have several common variations in their anatomy, such as pseudosubluxation of C2-C3, widening of the atlantodens interval, and ossification centers, that can appear concerning on imaging but are normal. Physicians should be alert for signs or symptoms of atlantorotary subluxation and spinal cord injury without radiologic abnormality when treating children with spinal cord injury, as these conditions have significant morbidity. MRI can identify injuries to the spinal cord that are not apparent with other modalities, and should be used when a child presents with a neurologic deficit but normal X-ray study or CT scan.


CONCLUSIONS
With knowledge of these variations in pediatric anatomy, emergency physicians can appropriately identify injuries to the cervical spine and determine when further imaging is needed.
Easter
Joshua S
JS
Department of Emergency Medicine, Children's Hospital of Boston, Boston, Massachusetts, USA.
Barkin
Roger
R
Rosen
Carlo L
CL
Ban
Kevin
K
D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004630:Emergencies; D005260:Female; D006801:Humans; D007103:Immobilization / Q000379:methods; D007223:Infant; D004204:Joint Dislocations / Q000175:diagnosis / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000628:therapy; D016103:Spinal Fractures / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D055815:Young Adult