Browse > Article
http://dx.doi.org/10.3340/jkns.2021.0282

Pediatric Spine Trauma  

An, Sungjae (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Hyun, Seung-Jae (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.65, no.3, 2022 , pp. 361-369 More about this Journal
Abstract
Pediatric spine has growth potential with incomplete ossification, and also unique biomechanics which have important implications for trauma patients. This article intends to review various aspects of pediatric spine trauma including epidemiology, anatomy and biomechanics, and clinically relevant details of each type of injury based on the location and mechanism of injury. With the appropriate but not superfluous treatment, pediatric spine trauma patients can have better chance of recovery. Therefore, as a spine surgeon, understanding the general concept for each injury subtype together with the debate and progress in the field is inevitable.
Keywords
Pediatrics; Trauma; Spinal injuries; Craniocervical injuries; Neurocentral junction;
Citations & Related Records
Times Cited By KSCI : 6  (Citation Analysis)
연도 인용수 순위
1 Hall GC, Kinsman MJ, Nazar RG, Hruska RT, Mansfield KJ, Boakye M, et al. : Atlanto-occipital dislocation. World J Orthop 6 : 236-243, 2015   DOI
2 Clark P, Letts M : Trauma to the thoracic and lumbar spine in the adolescent. Can J Surg 44 : 337-345, 2001
3 Durand D, Wu X, Kalra VB, Abbed KM, Malhotra A : Predictors of vertebral artery injury in isolated C2 fractures based on fracture morphology using CT angiography. Spine (Phila Pa 1976) 40 : E713-E718, 2015   DOI
4 Fielding JW, Hawkins RJ : Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 59 : 37-44, 1977   DOI
5 Hyun SJ, Lenke LG, Kim Y, Bridwell KH, Cerpa M, Blanke KM : The incidence of adding-on or distal junctional kyphosis in adolescent idiopathic scoliosis treated by anterior spinal fusion to l3 was significantly higher than by posterior spinal fusion to L3. Neurospine 18 : 457-463, 2021   DOI
6 Li XF, Dai LY, Lu H, Chen XD : A systematic review of the management of hangman's fractures. Eur Spine J 15 : 257-269, 2006   DOI
7 Jain NB, Ayers GD, Peterson EN, Harris MB, Morse L, O'Connor KC, et al. : Traumatic spinal cord injury in the United States, 1993-2012. JAMA 313 : 2236-2243, 2015   DOI
8 Lee SH, Hyun SJ, Jain A : Cervical sagittal alignment: literature review and future directions. Neurospine 17 : 478-496, 2020   DOI
9 Neal KM, Mohamed AS : Atlantoaxial rotatory subluxation in children. J Am Acad Orthop Surg 23 : 382-392, 2015   DOI
10 Momjian S, Dehdashti AR, Kehrli P, May D, Rilliet B : Occipital condyle fractures in children. Case report and review of the literature. Pediatr Neurosurg 38 : 265-270, 2003   DOI
11 Pang D, Li V : Atlantoaxial rotatory fixation: part 2--new diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging. Neurosurgery 57 : 941-953; discussion 941-953, 2005   DOI
12 Bonadio WA : Cervical spine trauma in children: part I. General concepts, normal anatomy, radiographic evaluation. Am J Emerg Med 11 : 158-165, 1993   DOI
13 Bozkus H, Ames CP, Chamberlain RH, Nottmeier EW, Sonntag VK, Papadopoulos SM, et al. : Biomechanical analysis of rigid stabilization techniques for three-column injury in the lower cervical spine. Spine (Phila Pa 1976) 30 : 915-922, 2005   DOI
14 Carreon LY, Glassman SD, Campbell MJ : Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech 17 : 477-482, 2004   DOI
15 Choi HY, Hyun SJ, Kim KJ, Jahng TA, Kim HJ : Radiographic and clinical outcomes following pedicle subtraction osteotomy : minimum 2-year follow-up data. J Korean Neurosurg Soc 63 : 99-107, 2020   DOI
16 Clayman DA, Sykes CH, Vines FS : Occipital condyle fractures: clinical presentation and radiologic detection. AJNR Am J Neuroradiol 15 : 1309-1315, 1994
17 Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA Jr, et al. : The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976) 32 : 2365-2374, 2007   DOI
18 Kulshrestha R, Kuiper JH, Masri WE, Chowdhury JR, Kaur S, Kumar N, et al. : Scoliosis in paediatric onset spinal cord injuries. Spinal Cord 58 : 711-715, 2020   DOI
19 Fujiwara H, Kaito T, Makino T, Yonenobu K : Positional occlusion of the vertebral artery in a case of rheumatoid atlantoaxial subluxation presenting with multiple cerebral and cerebellar infarction. Mod Rheumatol 22 : 605-609, 2012   DOI
20 Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN : Spinal injuries in children. J Pediatr Surg 39 : 607-612, 2004   DOI
21 Hyun SJ, Yoon SH, Kim JH, Oh JK, Lee CH, Shin JJ, et al. : A prospective, multi-center, double-blind, randomized study to evaluate the efficacy and safety of the synthetic bone graft material DBM gel with rhBMP-2 versus DBM gel used during the TLIF procedure in patients with lumbar disc disease. J Korean Neurosurg Soc 64 : 562-574, 2021   DOI
22 Gornet ME, Kelly MP : Fractures of the axis: a review of pediatric, adult, and geriatric injuries. Curr Rev Musculoskelet Med 9 : 505-512, 2016   DOI
23 Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, et al. : Diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery 50(3 Suppl) : S105-S113, 2002   DOI
24 Harris JH Jr, Carson GC, Wagner LK, Kerr N : Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 162 : 887-892, 1994   DOI
25 Kim CW, Hyun SJ, Kim KJ : Surgical impact on global sagittal alignment and health-related quality of life following cervical kyphosis correction surgery: systematic review. Neurospine 17 : 497-504, 2020   DOI
26 Kim YJ, Yoo CJ, Park CW, Lee SG, Son S, Kim WK : Traumatic atlantooccipital dislocation (AOD). Korean J Spine 9 : 85-91, 2012   DOI
27 Klimo P Jr, Ware ML, Gupta N, Brockmeyer D : Cervical spine trauma in the pediatric patient. Neurosurg Clin N Am 18 : 599-620, 2007   DOI
28 Konovalov N, Peev N, Zileli M, Sharif S, Kaprovoy S, Timonin S : Pediatric cervical spine injuries and SCIWORA: WFNS Spine Committee recommendations. Neurospine 17 : 797-808, 2020   DOI
29 Goel A : Torticollis and rotatory atlantoaxial dislocation: a clinical review. J Craniovertebr Junction Spine 10 : 77-87, 2019   DOI
30 Copley PC, Tilliridou V, Kirby A, Jones J, Kandasamy J : Management of cervical spine trauma in children. Eur J Trauma Emerg Surg 45 : 777-789, 2019   DOI
31 Coric D, Wilson JA, Kelly DL Jr : Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases. J Neurosurg 85 : 550-554, 1996   DOI
32 Dawkins RL, Miller JH, Menacho ST, Ramadan OI, Lysek MC, Kuhn EN, et al. : Thoracolumbar injury classification and severity score in children: a validity study. Neurosurgery 84 : E362-E367, 2019   DOI
33 Madura CJ, Johnston JM Jr : Classification and management of pediatric subaxial cervical spine injuries. Neurosurg Clin N Am 28 : 91-102, 2017   DOI
34 Pham MH, Cerpa M, Makhni MC, Sielatycki JA, Lenke LG : Neurologic deficit during halo-gravity traction in the treatment of severe thoracic kyphoscoliotic spinal deformity. Neurospine 17 : 461-465, 2020   DOI
35 Martinez-Lage JF, Martinez Perez M, Fernandez Cornejo V, Poza M : Atlanto-axial rotatory subluxation in children: early management. Acta Neurochir (Wien) 143 : 1223-1228, 2001   DOI
36 Pang D, Li V : Atlantoaxial rotatory fixation: part 3-a prospective study of the clinical manifestation, diagnosis, management, and outcome of children with alantoaxial rotatory fixation. Neurosurgery 57 : 954-972; discussion 954-972, 2005   DOI
37 Patel AA, Hurlbert RJ, Bono CM, Bessey JT, Yang N, Vaccaro AR : Classification and surgical decision making in acute subaxial cervical spine trauma. Spine (Phila Pa 1976) 35(21 Suppl) : S228-S234, 2010   DOI
38 Powers B, Miller MD, Kramer RS, Martinez S, Gehweiler JA Jr : Traumatic anterior atlanto-occipital dislocation. Neurosurgery 4 : 12-17, 1979   DOI
39 Radcliff KE, Hussain MM, Moldavsky M, Klocke N, Vaccaro AR, Albert TJ, et al. : In vitro biomechanics of the craniocervical junction-a sequential sectioning of its stabilizing structures. Spine J 15 : 1618-1628, 2015   DOI
40 Ranjith RK, Mullett JH, Burke TE : Hangman's fracture caused by suspected child abuse. A case report. J Pediatr Orthop B 11 : 329-332, 2002
41 Dogan S, Safavi-Abbasi S, Theodore N, Horn E, Rekate HL, Sonntag VK : Pediatric subaxial cervical spine injuries: origins, management, and outcome in 51 patients. Neurosurg Focus 20 : E1, 2006   DOI
42 Mahr D, Freigang V, Bhayana H, Kerschbaum M, Frankewycz B, Loibl M, et al. : Comprehensive treatment algorithm for atlanto-axial rotatory fixation (AARF) in children. Eur J Trauma Emerg Surg 47 : 713-718, 2021   DOI
43 Desai SS, Coumas JM, Danylevich A, Hayes E, Dunn EJ : Fracture of the occipital condyle: case report and review of the literature. J Trauma 30 : 240-241, 1990   DOI
44 Dickman CA, Greene KA, Sonntag VK : Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery 38 : 44-50, 1996   DOI
45 Dogan S, Safavi-Abbasi S, Theodore N, Chang SW, Horn EM, Mariwalla NR, et al. : Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases. J Neurosurg 106(6 Suppl) : 426-433, 2007
46 Mandabach M, Ruge JR, Hahn YS, McLone DG : Pediatric axis fractures: early halo immobilization, management and outcome. Pediatr Neurosurg 19 : 225-232, 1993   DOI
47 Fassett DR, McCall T, Brockmeyer DL : Odontoid synchondrosis fractures in children. Neurosurg Focus 20 : E7, 2006   DOI
48 Pang D, Li V : Atlantoaxial rotatory fixation: part 1--biomechanics of normal rotation at the atlantoaxial joint in children. Neurosurgery 55 : 614-625; discussion 625-626, 2004   DOI
49 Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA : Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br 63-B : 319-327, 1981   DOI
50 Ehrlich PF, Wee C, Drongowski R, Rana AR : Canadian C-spine rule and the national emergency X-radiography utilization low-risk criteria for C-spine radiography in young trauma patients. J Pediatr Surg 44 : 987-991, 2009   DOI
51 Fesmire FM, Luten RC : The pediatric cervical spine: developmental anatomy and clinical aspects. J Emerg Med 7 : 133-142, 1989   DOI
52 Dearolf WW 3rd, Betz RR, Vogel LC, Levin J, Clancy M, Steel HH : Scoliosis in pediatric spinal cord-injured patients. J Pediatr Orthop 10 : 214-218, 1990   DOI
53 Denis F : The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 8 : 817-831, 1983   DOI
54 Shim SC, Yoo DH, Lee JK, Koh HK, Lee SR, Oh SH, et al. : Multiple cerebellar infarction due to vertebral artery obstruction and bulbar symptoms associated with vertical subluxation and atlanto-occipital subluxation in ankylosing spondylitis. J Rheumatol 25 : 2464-2468, 1998
55 Rozzelle CJ, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Ryken TC, et al. : Management of pediatric cervical spine and spinal cord injuries. Neurosurgery 72 Suppl 2 : 205-226, 2013   DOI
56 Savage JW, Moore TA, Arnold PM, Thakur N, Hsu WK, Patel AA, et al. : The reliability and validity of the thoracolumbar injury classification system in pediatric spine trauma. Spine (Phila Pa 1976) 40 : E1014-E1018, 2015   DOI
57 Sayama C, Chen T, Trost G, Jea A : A review of pediatric lumbar spine trauma. Neurosurg Focus 37 : E6, 2014   DOI
58 Stulik J, Geri G, Salavcova L, Barna M, Fojtik P, Nanka O : Pediatric dens anatomy and its implications for fracture treatment: an anatomical and radiological study. Eur Spine J 30 : 416-424, 2021   DOI
59 Treloar DJ, Nypaver M : Angulation of the pediatric cervical spine with and without cervical collar. Pediatr Emerg Care 13 : 5-8, 1997   DOI
60 Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR, et al. : A prospective multicenter study of cervical spine injury in children. Pediatrics 108 : E20, 2001   DOI
61 Kleinman PK : Hangman's fracture caused by suspected child abuse. J Pediatr Orthop B 13 : 348; author reply 348, 2004   DOI
62 White AA 3rd, Johnson RM, Panjabi MM, Southwick WO : Biomechanical analysis of clinical stability in the cervical spine. Clin Orthop Relat Res (109) : 85-96, 1975
63 Harris JH Jr, Carson GC, Wagner LK : Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 162 : 881-886, 1994   DOI
64 Herman MJ, Brown KO, Sponseller PD, Phillips JH, Petrucelli PM, Parikh DJ, et al. : Pediatric cervical spine clearance: a consensus statement and algorithm from the Pediatric Cervical Spine Clearance Working Group. J Bone Joint Surg Am 101 : e1, 2019   DOI
65 Hyun SJ, Lenke LG, Kim Y, Bridwell KH, Cerpa M, Blanke KM : Adolescent idiopathic scoliosis treated by posterior spinal segmental instrumented fusion : when is fusion to L3 stable? J Korean Neurosurg Soc 64 : 776-783, 2021   DOI
66 Jabbour P, Fehlings M, Vaccaro AR, Harrop JS : Traumatic spine injuries in the geriatric population. Neurosurg Focus 25 : E16, 2008
67 Judd DB, Liem LK, Petermann G : Pediatric atlas fracture: a case of fracture through a synchondrosis and review of the literature. Neurosurgery 46 : 991-994; discussion 994-995, 2000   DOI
68 Kim CW, Hyun SJ, Kim KJ : Systematic review of reciprocal changes after spinal reconstruction surgery : do not miss the forest for the trees. J Korean Neurosurg Soc 64 : 843-852, 2021   DOI
69 Korean Statistical Information Service (KOSIS) : 2017 National children abuse report. Daejeon : KOSIS, 2017
70 Lee C, Woodring JH, Goldstein SJ, Daniel TL, Young AB, Tibbs PA : Evaluation of traumatic atlantooccipital dislocations. AJNR Am J Neuroradiol 8 : 19-26, 1987
71 Leventhal HR : Birth injuries of the spinal cord. J Pediatr 56 : 447-453, 1960   DOI
72 Monckeberg JE, Tome CV, Matias A, Alonso A, Vasquez J, Zubieta JL : CT scan study of atlantoaxial rotatory mobility in asymptomatic adult subjects: a basis for better understanding C1-C2 rotatory fixation and subluxation. Spine (Phila Pa 1976) 34 : 1292-1295, 2009   DOI
73 Panjabi M, Dvorak J, Duranceau J, Yamamoto I, Gerber M, Rauschning W, et al. : Three-dimensional movements of the upper cervical spine. Spine (Phila Pa 1976) 13 : 726-730, 1988   DOI
74 Platzer P, Jaindl M, Thalhammer G, Dittrich S, Kutscha-Lissberg F, Vecsei V, et al. : Cervical spine injuries in pediatric patients. J Trauma 62 : 389-396; discussion 394-39, 2007   DOI
75 Slaar A, Fockens MM, Wang J, Maas M, Wilson DJ, Goslings JC, et al. : Triage tools for detecting cervical spine injury in pediatric trauma patients. Cochrane Database Syst Rev 12 : CD011686, 2017
76 Liao S, Jung MK, Hornig L, Grutzner PA, Kreinest M : Injuries of the upper cervical spine-how can instability be identified? Int Orthop 44 : 1239-1253, 2020   DOI
77 Vitale MG, Goss JM, Matsumoto H, Roye DP Jr : Epidemiology of pediatric spinal cord injury in the United States: years 1997 and 2000. J Pediatr Orthop 26 : 745-749, 2006   DOI
78 Wui SH, Hyun SJ, Kang B, Kim KJ, Jahng TA, Kim HJ : Bicortical screw purchase at upper instrumented vertebra (UIV) can cause UIV fracture after adult spinal deformity surgery: a finite element analysis study. Neurospine 17 : 377-383, 2020   DOI
79 Lipson SJ : Rheumatoid arthritis in the cervical spine. Clin Orthop Relat Res (239) : 121-127, 1989
80 Launay F, Leet AI, Sponseller PD : Pediatric spinal cord injury without radiographic abnormality: a meta-analysis. Clin Orthop Relat Res (433) : 166-170, 2005
81 Maat GJ, Matricali B, van Persijn van Meerten EL : Postnatal development and structure of the neurocentral junction. Its relevance for spinal surgery. Spine (Phila Pa 1976) 21 : 661-666, 1996   DOI
82 Maiman DJ, Cusick JF : Traumatic atlantoaxial dislocation. Surg Neurol 18 : 388-392, 1982   DOI
83 McCall T, Fassett D, Brockmeyer D : Cervical spine trauma in children: a review. Neurosurg Focus 20 : E5, 2006
84 Salunke P, Sahoo SK, Deepak AN, Garg R : Congenital C1-2 lateral translational dislocation: case illustration with pre- and postoperative imaging. Pediatr Neurosurg 51 : 218-220, 2016   DOI
85 Been HD, Kerkhoffs GM, Maas M : Suspected atlantoaxial rotatory fixation-subluxation: the value of multidetector computed tomography scanning under general anesthesia. Spine (Phila Pa 1976) 32 : E163-E167, 2007   DOI
86 Anderson PA, Montesano PX : Morphology and treatment of occipital condyle fractures. Spine (Phila Pa 1976) 13 : 731-736, 1988   DOI
87 Park BJ, Hyun SJ, Wui SH, Jung JM, Kim KJ, Jahng TA : Surgical outcomes and complications following all posterior approach for spinal deformity associated with neurofibromatosis type-1. J Korean Neurosurg Soc 63 : 738-746, 2020   DOI
88 Adams VI : Neck injuries: III. Ligamentous injuries of the craniocervical articulation without occipito-atlantal or atlanto-axial facet dislocation. A pathologic study of 21 traffic fatalities. J Forensic Sci 38 : 1097-1104, 1993   DOI
89 Stein DM, Knight WA 4th : Emergency neurological life support: traumatic spine injury. Neurocrit Care 27(Suppl 1) : 170-180, 2017   DOI
90 Slotkin JR, Lu Y, Wood KB : Thoracolumbar spinal trauma in children. Neurosurg Clin N Am 18 : 621-630, 2007   DOI
91 Theodore N, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, et al. : The diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery 72 Suppl 2 : 114-126, 2013   DOI
92 Traynelis VC, Marano GD, Dunker RO, Kaufman HH : Traumatic atlantooccipital dislocation. Case report. J Neurosurg 65 : 863-870, 1986   DOI
93 Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, et al. : AOSpine subaxial cervical spine injury classification system. Eur Spine J 25 : 2173-2184, 2016   DOI
94 Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M : Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 21 : 1454-1460, 1992   DOI
95 Kim DH, Hyun SJ, Kim KJ : Selection of fusion level for adolescent idiopathic scoliosis surgery : selective fusion versus postoperative decompensation. J Korean Neurosurg Soc 64 : 473-485, 2021   DOI
96 Barber I, Perez-Rossello JM, Wilson CR, Silvera MV, Kleinman PK : Prevalence and relevance of pediatric spinal fractures in suspected child abuse. Pediatr Radiol 43 : 1507-1515, 2013   DOI
97 An Z, Zhu Y, Wang G, Wei H, Dong L : Is the thoracolumbar AOSpine injury score superior to the thoracolumbar injury classification and severity score for guiding the treatment strategy of thoracolumbar spine injuries? World Neurosurg 137 : e493-e498, 2020   DOI
98 Dauleac C, Mottolese C, Beuriat PA, Szathmari A, Di Rocco F : Superiority of thoracolumbar injury classification and severity score (TLICS) over AOSpine thoracolumbar spine injury classification for the surgical management decision of traumatic spine injury in the pediatric population. Eur Spine J 30 : 3036-3042, 2021   DOI
99 Abumi K, Fujiya M, Saita M, Kaneda K : Occipitoatlantal instability associated with articular tropism. Eur Spine J 7 : 76-79, 1998   DOI
100 Baumann F, Ernstberger T, Neumann C, Nerlich M, Schroeder GD, Vaccaro AR, et al. : Pediatric cervical spine injuries: a rare but challenging entity. J Spinal Disord Tech 28 : E377-E384, 2015   DOI
101 Bhatnagar M, Sponseller PD, Carroll C 4th, Tolo VT : Pediatric atlantoaxial instability presenting as cerebral and cerebellar infarcts. J Pediatr Orthop 11 : 103-107, 1991   DOI
102 Ma F, He H, Liao Y, Tang Q, Tang C, Yang S, et al. : Classification of the facets of lateral atlantoaxial joints in patients with congenital atlantoaxial dislocation. Eur Spine J 29 : 2769-2777, 2020   DOI