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  • Cervical spine injury should be suspected in any child who has suffered traumatic respiratory arrest and rapid sequence orotracheal intubation should be preformed with in-line cervical spine stabilization.
  • Because of differences in anatomy and physiology, children sustain proportionally more upper cervical spine and spinal cord injury without radiographic abnormality (SCIWORA) injuries compared to adults.
  • Standard radiographic screening for children consists of the AP, lateral, and open-mouth views; however, in younger or uncooperative children, the open-mouth view can be omitted. CT scan is more sensitive for bony injury and MRI for soft tissue injury.
  • Although spine immobilization is indicated when cervical spine injury is suspected, there are documented complications and decisions to immobilize should be selective and target those at greatest risk for cervical spine injury.


Cervical spine injuries are serious, but rare events in children.1,2 Emergency physicians are often the first to evaluate pediatric trauma patients with cervical spine injury and are required to quickly sort children with the potential for worsening neurological deficits from those with either no cervical spine injury or cervical sprain. Occasionally, these decisions are made in the absence of adequate cervical spine imaging when dealing with a child's unstable airway or other life-threatening injuries. These challenges raise some specific questions:


  • Are there specific subsets of children who present to the emergency department and are at the highest risk for cervical spine injuries?
  • Which children should be immobilized and how is this best achieved?
  • How is the cervical spine “cleared”?
  • If an artificial airway is needed, how should it be provided in children who may have cervical spine injuries?


Traumatic injury is the leading cause of morbidity and mortality in children, yet cervical spine injury represents a small subset of those injured. Cervical spine injury affects less than 1% of children undergoing emergency department trauma evaluation and only 1.5% of children enrolled in the National Pediatric Trauma Registry.3,4 It is estimated that there is an overall 17% mortality associated with cervical spine injury in children; however, this rate may be as high as 60% in children ≤8 years.4 This increased risk of mortality is likely associated with proportionately higher rate of upper cervical spine injury in young children.4


Within the pediatric population, motor vehicle collisions are the most common cause of cervical spine injuries.5,6 However, the mechanisms vary by age. Neonates may suffer cervical spine injuries from birth trauma, particularly in the case of breech or forceps deliveries.7,8 The incidence of nonaccidental trauma is likely underestimated in the pediatric population.9 Sports-related injuries, pedestrians hit by motor vehicles, and falls are common mechanisms of cervical spine injury in older children and teenagers; while violent injuries, including assault and gunshot wounds, are causes of cervical spine injuries in the late teenage years.5,6


It is essential to understand the developmental anatomy of the ...

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