Paediatric cervical spine injuries - A descriptive analysis of thirty-two years of experience at a trauma centre.

PURPOSE: This study aims to describe and analyse pediatric cervical spine (C-spine) trauma over 32 years at a level 1 trauma centre.

METHODS

A retrospective observational study was conducted, including patients younger than 16 years hospitalised after C-spine trauma from 1991 to 2022. Data on demographics, injury mechanisms, affected levels, associated injuries, neurological deficits (Frankel scale), treatments, and outcomes were analysed. Patients were divided into two age groups: < eight years (Group A) and nine to 16 years (Group B). Injuries were categorised as SCIWORA or skeletal, and by level-upper (C0 to C2) or lower (C3 to C7). Statistical analysis was performed using SPSS v29.0 (p < 0.05).

RESULTS

A total of 102 patients were identified (67% male; 65% > 8 years). Younger children had more upper C-spine injuries (55.6%), lower injuries were more common in Group B (53%) (p = 0.006). mechanisms included motor vehicle accidents, pedestrian accidents, falls, and sports injuries. Associated injuries were present in 59% of cases, mainly head trauma. SCIWORA occurred in 14.7% of patients, with MRI-confirmed cord contusions in 60% of these. Most patients (74.7%) underwent conservative treatment. Neurological deficits were present in 38% of patients, and 51.2% showed improvement. The mortality rate was 16.5%, significantly higher among those with neurological impairment (p = 0.004).

CONCLUSION

Pediatric C-spine trauma is uncommon. MRI is essential for detecting spinal cord injury in SCIWORA. The high prevalence and impact of associated injuries on mortality highlight the need for thorough primary evaluation. Multicenter studies are necessary to improve management strategies and outcomes.