Maturity of the spine and spine-supporting structures is an important variable distinguishing spinal cord injuries in children from those in adults. Clinical data are presented from 71 children aged 12 years or younger who constituted 2.7% of 2598 spinal cord-injured patients admitted to the authors' institutions from June, 1972, to June, 1986. The 47 children with traumatic spinal cord injury averaged 6.9 years of age and included 20 girls (43%). The etiology of the pediatric injuries differed from that of adult injuries in that falls were the most common causative factor (38%) followed by automobile-related injuries (20%). Ten children (21.3%) had spinal cord injury without radiographic abnormality (SCIWORA), whereas 27 (57%) had evidence of neurological injury. Complete neurological injury was seen in 19% of all traumatic pediatric spinal cord injuries and in 40% of those with SCIWORA. The most frequent level of spinal injury was C-2 (27%, 15 cases) followed by T-10 (13%, seven cases). Upon statistical examination of the data, a subpopulation of children aged 3 years or younger emerged. These very young children had a significant difference in level of injury, requirement for surgical stability, and sex distribution compared to 4- to 12-year-old children.

Review of 70 children presenting with a solitary nontraumatic lump on the head revealed that 61% of the lesions were dermoid tumor, 9% were cephalhematoma deformans, 7% were eosinophilic granuloma, and 4% were occult meningoceles and encephaloceles. Most of the dermoid cysts occurred along sutural lines, but some did not. One of the eosinophilic granulomas was located over the sagittal suture. Seventeen per cent of the "lumps" had significant intracranial extension. An additional 20% of the lumps extended intracranially, but only to the dura mater. Work-up of these lesions should include initial plain skull roentgenograms to assess multiplicity and appropriate computed tomographic scans to assess possible intracranial extension.

Intracranial tuberculomas generally present as either solitary or multiple lesions in the brain parenchyma. They are characterized by a ring-enhancing area on either computerized tomography scans or magnetic resonance images. A case is presented in which an intracranial tuberculoma was dural based and had an appearance similar to an en plaque meningioma.

Pediatric C-2 fractures have been managed with initial cranial skeletal tong traction or a period of bed rest for reduction and alignment followed by external and/or surgical stabilization. Thirteen children were managed with early halo orthosis to provide the initial reduction/alignment and to accomplish long-term stabilization. Eighty percent had fusion with the halo alone, and 20% went on to fuse after surgery. The average hospitalization for isolated C-2 injury was 10.6 days. Minor complications occurred in 46% of the patients. The literature is reviewed as to the management and outcome of pediatric axis fractures.