Birth injuries of the spinal cord

Leventhal, Harvey R.

doi:10.1016/s0022-3476(60)80356-3

Cited by 133 publications

(59 citation statements)

References 18 publications

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“…A mechanism is postulated which is entirely compatible with the evidence, both macroscopic and microscopic, which has been described by Bedbrook (1966) in adults. This postulated mechan ism is compatible with, and strengthened by, Leventhal's (1960) experiments with autopsy specimens in which he demonstrated that the spine of the neonate can be stretched 2 inches whilst the cervical spinal cord can be pulled down only one quarter of an inch before rupturing. It is also possible to use the hypothesis of a longitudinal traction injury mechanism to explain the permanently flaccid lesions below D4 and D3 in the two children described by Burke (1971) and the lesion of Patient NO.1 in the present series.…”

Section: Pathologysupporting

confidence: 53%

The paediatric syndrome of traumatic myelopathy without demonstrable vertebral injury

Cheshire

1977

Spinal Cord

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Abstract. Three detailed case histories are added to those previously published in the literature and from the evidence now available a proposal is made that a paediatric syndrome of traumatic myelopathy without demonstrable vertebral injury be recognised as a definite clinical entity. The mechanisms of injury, evolution, patterns of paralysis and pathological evidence are discussed. The conclusion is drawn that no form of treatment yet known can influence the prognosis in this syndrome.

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Section: Pathologysupporting

confidence: 53%

The paediatric syndrome of traumatic myelopathy without demonstrable vertebral injury

Cheshire

1977

Spinal Cord

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“…This confirms observations of most but not all earlier studies, in which the distribution of CSI in children who are older than 12 years is similar to that of adults, whereas the preponderance of injuries in younger children is in the C1 and C2 regions. 9,10,[15][16][17] SCIWORA has been described prominently among children, 7,25,26 but the only such cases in NEXUS occurred among adults. Because for the purpose of this study we could confirm the presence of a cord injury only when it was diagnosed radiographically (typically by MRI) at the participating institution, it is possible that the 5 children who were reported to have cord injury represent an underestimate of the true number of children with cord injury.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Multicenter Study of Cervical Spine Injury in Children

et al. 2001

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ABSTRACT. Objective. Pediatric victims of blunt trauma have developmental and anatomic characteristics that can make it difficult to assess their risk of cervical spine injury (CSI). Previous reports, all retrospective in nature, have not identified any cases of CSI in either children or adults in the absence of neck pain, neurologic symptoms, distracting injury, or altered mental status. The objective of this study was to examine the incidence and spectrum of spine injury in patients who are younger than 18 years and to evaluate the efficacy of the National Emergency X-Radiography Utilization Study (NEXUS) decision instrument for obtaining cervical spine radiography in pediatric trauma victims.Methods. We performed a prospective, multicenter study to evaluate pediatric blunt trauma victims. All patients who presented to participating emergency departments underwent clinical evaluation before radiographic imaging. The presence or absence of the following criteria was noted: midline cervical tenderness, altered level of alertness, evidence of intoxication, neurologic abnormality, and presence of painful distracting injury. Presence or absence of each individual criterion was documented for each patient before radiographic imaging, unless the patient was judged to be too unstable to complete the clinical evaluation before radiographs. The decision to radiograph a patient was entirely at the physician's discretion and not driven by the NEXUS questionnaire. The presence or absence of CSI was based on the final interpretation of all radiographic studies. Data on all patients who were younger than 18 years were sequestered from the main database for separate analysis.Results. There were 3065 patients (9.0% of all NEXUS patients) who were younger than 18 years in this cohort, 30 of whom (0.98%) sustained a CSI. Included in the study were 88 children who were younger than 2, 817 who were between 2 and 8, and 2160 who were 8 to 17. Fractures of the lower cervical vertebrae (C5-C7) accounted for 45.9% of pediatric CSIs. No case of spinal cord injury without radiographic abnormality was reported in any child in this study, although 22 cases were reported in adults. Only 4 of the 30 injured children were younger than 9 years, and none was younger than 2 years. Tenderness and distracting injury were the 2 most common abnormalities noted in patients with and without CSI. The decision rule correctly identified all pediatric CSI victims (sensitivity: 100.0%; 95% confidence interval: 87.8%-100.0%) and correctly designated 603 patients as low risk for CSI (negative predictive value: 100.0%; 95% confidence interval: 99.4%-100.0%).Conclusions. The lower cervical spine is the most common site of CSI in children, and fractures are the most common type of injury. CSI is rare among patients aged 8 years or younger. The NEXUS decision instrument performed well in children, and its use could reduce pediatric cervical spine imaging by nearly 20%. However, the small number of infants and toddlers in the study suggests caution in applying t...

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“…43 In a study of neonatal cadavers, the vertebral column could stretch as much as 2 in without disruption, but the spinal cord could only stretch 0.25 in. 58 This elasticity is a result of several distinct features of the pediatric cervical spine. First, the facet joints are more shallow than in the adult spine and are oriented horizontally.…”

Section: Causes Of Scimentioning

confidence: 99%

“…2,21,101 Factors predisposing young children to SCIWORA include a more tenuous spinal cord blood supply 22 and greater elasticity in the vertebral column than in the spinal cord. 58 Flexion and extension injuries are the most common mechanism, but lateral bending, distraction, rotation, axial loading, or a combination may also be involved.…”

mentioning

confidence: 99%

Cervical spine trauma in children: a review

McCall¹,

Fassett²,

Brockmeyer³

2006

FOC

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✓ Injuries of the cervical spine are relatively rare in children but are a distinct clinical entity compared with those found in adults. The unique biomechanics of the pediatric cervical spine lead to a different distribution of injuries and distinct radiographic features. Children younger than 9 years of age usually have upper cervical injuries, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. Pediatric cervical injuries are more frequently ligamentous in nature, and children are also more prone to spinal cord injury without radiographic abnormality than adults are. Physial injuries are specific only to children. Radiographically benign findings, such as pseudosubluxation and synchondrosis, can be mistaken for traumatic injuries. External immobilization with a halo brace can be difficult and is associated with a high complication rate because of the thin calvaria in children. Surgical options have improved with the development of instrumentation specifically for children, but special considerations exist, such as the small size and growth potential of the pediatric spine.

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Birth injuries of the spinal cord

Cited by 133 publications

References 18 publications

The paediatric syndrome of traumatic myelopathy without demonstrable vertebral injury

The paediatric syndrome of traumatic myelopathy without demonstrable vertebral injury

A Prospective Multicenter Study of Cervical Spine Injury in Children

Cervical spine trauma in children: a review

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