Prevalence of cervical spine injury in infants with head trauma. Joel S Katz, Chima O Oluigbo, C Corbett Wilkinson, Sean McNatt, Michael H Handler. J Neurosurg Pediatrics 2010;5:470-473. (from Aurora, CO)
Review from Autumn 2010 issue
The authors reviewed the Children’s Hospital trauma database in Colorado from 1993 to 2007, searching for infants less than one year old with head trauma. They identified 905 patients with a mean age of 4.3 months. Those who were the victims of motor vehicle events or falls of more than ten feet were excluded.
Fifty-four percent of the study sample had been injured in falls, 39% were the victims of child abuse, 2.5% were struck by an object, and 2.8% had other causes of injury. Thirty percent had dedicated spine X-rays, 49% had skeletal surveys, 3% had spinal CTs and 1% had spinal MRIs. In all, 62% had the spine evaluated by some form of imaging; the diagnosis was cleared clinically in the rest.
Only two children had recognized cervical spinal injury. One, a six-month-old infant with a pneumomediastinum extending into the neck, had a small ventral epidural hemorrhage at autopsy. A two-month-old had a unilateral laminar fracture of C-4. Neither child had symptomatic cervical injury or required intervention for the spinal injury. Both children had been abused.
The prevalence of cervical spine injury was 0.2% in the entire series, 0.5% among abused infants, and 3% among the 33 fatalities. On follow-up, no additional spinal injuries were found.
Reviewed by Kenneth Feldman, M.D.
This series included few cases evaluated with the more detailed imaging techniques of CT or MRI scans. As such, it probably underestimates the rate of cervical injuries that are not apparent clinically. Brennan4 also observed that autopsy evidence of cervical injury in abused, head-injured infants is much more common (71%) than is clinically apparent.
It would behoove us to look more closely for clinical evidence of cervical injury and to use the most specific imaging. When possible, we should use CT for bony injury and MRI for cord and soft tissue injury.
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