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TOPIC: Cervical Spine Trauma in Children: A Review

Cervical Spine Trauma in Children: A Review 23 Mar 2013 22:57 #77

Cervical Spine Trauma in Children: A Review

Anatomy and Biomechanics
The unique anatomy and biomechanics of the pediatric cervical spine help explain the different radiographic features, injury patterns, and management options found in children compared with those in adults. The principal difference is that the pediatric cervical spine is intrinsically more elastic compared with that of adults, especially in the first 8 years of life. In a study of neonatal cadavers, the vertebral column could stretch as much as 2" without disruption, but the spinal cord could only stretch 0.25". 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. This has the effect of increasing translational mobility and movement during flexion and extension. Second, spinal ligaments and joint capsules can withstand significant stretching without tearing, which contributes to the occurrence of pseudosubluxation. Third, several authors have argued that the anterior wedging of the VBs allows ventral slippage between motion segments, although others have noted that the wedging that appears on radiographs is due to a ring apophysis that does not ossify before the age of 12 years, and that therefore this is merely a radiographic and not an anatomical finding. Finally, absent uncinate processes and weak nuchal muscles also lend more flexibility to the spine.


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