Radiology of the Pediatric Cervical Spine

- See:
        - development of atlas
        - development of axis

- Discussion:
    - most pediatric C-spine injuries will occur above C3, and therefore lateral radiographs should be centered on C-3;
    - Atlantoaxial Rotatory Fixation:
    - SCIWORA: Syndrome of Spinal Cord Injury w/o Radiographic Abnormality;
           - accounts for up to 2/3 of severe cervical injuries in children < 8 years of age;
           - inherent elasticity in pediatric cervical spine can allow severe spinal cord injury to occur in absence of x-ray findings;
           - fracture through the cartilaginous end plates (which are not visualized by x-rays), may be among the causes of this injury;
           - radiographs:
                   - diagnosis of exclusion:
                   - MRI may give a more anatomic diagnosis by showing hemorrhage or edema of the spinal cord;
                   - pseudosubluxation: anterior displacement may be up to 4 mm;
           - treatment: spine is immobilized for one to three weeks;


- Radiographs:
    - lateral radiograph in children < 10 yrs of age:
           - atlantooccipital disassociation
           - atlas dens interval < 3.5 mm
           - cervical stenosis:
           - retropharyngeal space: (will increase w/ crying)
                 - C3: < 6-8 mm;
                 - C6: < 14 mm;
           - odontoid frxs: accounts for majority of pediatric C-spine frx (upto 75%)
           - development & anomalies of axis: (os odontoideum):
           - pseudosubluxation C2-3: 0-3 mm
                 - note that pediatric trauma patients should be placed on a trauma board which allows the head to slightly hyperextend;
                 - when placed on a standard truama board, the child's neck will flex (due to the large pediatric head size), which accentuates pseudosubluxation;
           - canal width: 14 mm;
                 - spinous process widening:
                 - C1-C2 interspinous space should not be greater than 10 mm;
                 - widening is present when the distance is more than 1.5 times the inter-spinous distance of adjacent spinal segments;
    - odontoid view:
           - combined lateral overhang of more than 7 mm of (C1-C2 facets) indicates an unstable Jefferson's Fracture;
    - oblique view:
           - oblique radiographs are not essential in the pediatric population, since facet injuries are uncommon



The surgical treatment of instability of the upper part of the cervical spine in children and adolescents.

Fusion of the upper cervical spine in children and adolescents. An analysis of 17 patients.

The anterior cervical approach for traumatic injuries to the cervical spine in children.

Cervical disc calcification in children: A long term review

Acute fractures and dislocations of the cervical spine in children and adolescents.

Intervertebral disc calcification syndromes in children.  

Congenital anomalies of the cervical spine

Familial cervical dysplasia.

Pediatric spinal injury: the very young

Pediatric spinal trauma. Review of 122 cases of spinal cord and vertebral column injury

Cervical spine injuries in childhood

Cervical Spine Fracture-Dislocation Birth Injury: Prevention, Recognition, and Implications for the Orthopaedic Surgeon.

Cervical spine injuries in pediatric patients.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 4:47 pm