Abstract：
OBJECTIVE: Pediatric cervical spine injuries (CSI) can be devastating, and children < 8 years are particularly at risk for upper CSI given unique anatomical differences. Diagnosis of these injuries can be delayed due to variable clinical presentations and a paucity of existing literature. The authors aimed to characterize the spectrum of pediatric upper CSI.
METHODS: This was a retrospective, single-center case series of trauma patients aged < 16 years who were assessed at a level I pediatric trauma center and diagnosed with upper CSI between 2000 and 2020. Patients were included if they had evidence of bony or ligamentous injury from the occiput to C2 on imaging or autopsy. Data were obtained from manual chart review and analyzed using descriptive statistics.
RESULTS: In total, 502 patients were screened and 202 met inclusion criteria. Of these, 31 (15%) had atlanto-occipital (AO) joint distractions, 10 (5%) had atlanto-axial (AA) joint distractions, 31 (15%) had fractures of C1-2, and 130 (64%) had ligamentous injury without joint distraction. Of the patients with AO injury, 15 patients had complete dislocation. They presented as hemodynamically unstable with signs of herniation and 14 died (93%). In contrast, 16 had incomplete dislocation (subluxation). They usually had stable presentations and survived with good outcomes. Of the patients with AA injury, 2 had complete dislocation, presented with arrest and signs of herniation, and died. In contrast, 8 patients with subluxation mostly presented as clinically stable and all survived with little residual disability. The most common fractures of C1 were linear fractures of the lateral masses and of the anterior and posterior arches. The most common fractures of C2 were synchondrosis, hangman, and odontoid fractures. Overall, these patients had excellent outcomes. Ligamentous injuries frequently accompanied other brain or spine injuries. When these injuries were isolated, patients recovered well.
CONCLUSIONS: Among upper CSI, AO and AA joint injuries emerged as particularly severe with high mortality rates. Both could be divided into complete dislocations or incomplete subluxations, with clear clinical differences and the former presenting with much more severe injuries. Lateral cervical spine radiography should be considered during resuscitation of unstable trauma patients to assess for these CSI subtypes. Fractures and ligamentous injuries were clinically heterogeneous, with presentations and outcomes depending on severity and associated injuries.
METHODS: This was a retrospective, single-center case series of trauma patients aged < 16 years who were assessed at a level I pediatric trauma center and diagnosed with upper CSI between 2000 and 2020. Patients were included if they had evidence of bony or ligamentous injury from the occiput to C2 on imaging or autopsy. Data were obtained from manual chart review and analyzed using descriptive statistics.
RESULTS: In total, 502 patients were screened and 202 met inclusion criteria. Of these, 31 (15%) had atlanto-occipital (AO) joint distractions, 10 (5%) had atlanto-axial (AA) joint distractions, 31 (15%) had fractures of C1-2, and 130 (64%) had ligamentous injury without joint distraction. Of the patients with AO injury, 15 patients had complete dislocation. They presented as hemodynamically unstable with signs of herniation and 14 died (93%). In contrast, 16 had incomplete dislocation (subluxation). They usually had stable presentations and survived with good outcomes. Of the patients with AA injury, 2 had complete dislocation, presented with arrest and signs of herniation, and died. In contrast, 8 patients with subluxation mostly presented as clinically stable and all survived with little residual disability. The most common fractures of C1 were linear fractures of the lateral masses and of the anterior and posterior arches. The most common fractures of C2 were synchondrosis, hangman, and odontoid fractures. Overall, these patients had excellent outcomes. Ligamentous injuries frequently accompanied other brain or spine injuries. When these injuries were isolated, patients recovered well.
CONCLUSIONS: Among upper CSI, AO and AA joint injuries emerged as particularly severe with high mortality rates. Both could be divided into complete dislocations or incomplete subluxations, with clear clinical differences and the former presenting with much more severe injuries. Lateral cervical spine radiography should be considered during resuscitation of unstable trauma patients to assess for these CSI subtypes. Fractures and ligamentous injuries were clinically heterogeneous, with presentations and outcomes depending on severity and associated injuries.
摘要：
目的：儿童颈椎损伤（CSI）可能是毁灭性的，鉴于独特的解剖学差异，<8岁的儿童尤其面临上CSI的风险。由于临床表现的差异和现有文献的匮乏，这些损伤的诊断可能会延迟。作者旨在表征儿科上CSI的频谱。
方法：这是一个回顾性研究，单中心病例系列，年龄<16岁的创伤患者在I级儿科创伤中心进行评估，并在2000年至2020年间诊断为上CSI。如果患者在影像学或尸检中有从枕骨到C2的骨或韧带损伤的证据，则将其包括在内。数据来自手动图表审查，并使用描述性统计进行分析。
结果：总计，对502例患者进行了筛选，202例符合纳入标准。其中,31（15％）有寰枕（AO）关节分散，10人（5%）有寰枢椎（AA）关节牵张，31例（15％）发生C1-2骨折，130例（64％）发生韧带损伤，无关节牵张。在AO受伤的患者中，15例患者出现完全脱位。他们表现为血流动力学不稳定，有疝的迹象，14人死亡（93％）。相比之下,16有不完全脱位(半脱位)。他们通常有稳定的演讲，并以良好的结果幸存下来。在AA损伤的患者中，2有完全脱位，被逮捕和突出的迹象，死了.相比之下,8例半脱位患者大多表现为临床稳定，全部存活，几乎没有残留残疾。C1最常见的骨折是侧块以及前后弓的线性骨折。最常见的C2骨折是软骨综合征，Hangman,齿状突骨折.总的来说,这些患者的预后非常好.韧带损伤经常伴随其他脑或脊柱损伤。当这些伤口被隔离时，患者恢复良好。
结论：在上CSI中，AO和AA关节损伤尤其严重，死亡率高。两者都可以分为完全脱位或不完全脱位，具有明显的临床差异，前者表现出更严重的伤害。在不稳定创伤患者的复苏过程中，应考虑进行颈椎侧位X线摄影，以评估这些CSI亚型。骨折和韧带损伤在临床上是异质的，介绍和结果取决于严重程度和相关伤害。
方法：这是一个回顾性研究，单中心病例系列，年龄<16岁的创伤患者在I级儿科创伤中心进行评估，并在2000年至2020年间诊断为上CSI。如果患者在影像学或尸检中有从枕骨到C2的骨或韧带损伤的证据，则将其包括在内。数据来自手动图表审查，并使用描述性统计进行分析。
结果：总计，对502例患者进行了筛选，202例符合纳入标准。其中,31（15％）有寰枕（AO）关节分散，10人（5%）有寰枢椎（AA）关节牵张，31例（15％）发生C1-2骨折，130例（64％）发生韧带损伤，无关节牵张。在AO受伤的患者中，15例患者出现完全脱位。他们表现为血流动力学不稳定，有疝的迹象，14人死亡（93％）。相比之下,16有不完全脱位(半脱位)。他们通常有稳定的演讲，并以良好的结果幸存下来。在AA损伤的患者中，2有完全脱位，被逮捕和突出的迹象，死了.相比之下,8例半脱位患者大多表现为临床稳定，全部存活，几乎没有残留残疾。C1最常见的骨折是侧块以及前后弓的线性骨折。最常见的C2骨折是软骨综合征，Hangman,齿状突骨折.总的来说,这些患者的预后非常好.韧带损伤经常伴随其他脑或脊柱损伤。当这些伤口被隔离时，患者恢复良好。
结论：在上CSI中，AO和AA关节损伤尤其严重，死亡率高。两者都可以分为完全脱位或不完全脱位，具有明显的临床差异，前者表现出更严重的伤害。在不稳定创伤患者的复苏过程中，应考虑进行颈椎侧位X线摄影，以评估这些CSI亚型。骨折和韧带损伤在临床上是异质的，介绍和结果取决于严重程度和相关伤害。
