A major challenge with spinal cord injury in children is the combination of its relative rarity and its potentially serious consequences. Missed diagnosis of a spinal injury (eg, a C2 fracture with anterior dislocation [see Figure 1]) can lead to permanent injury. Cervical spinal injury (CSI) occurs in about 1% to 1.5% of children evaluated following blunt trauma.1,2 The majority of these injuries are in older children; < 5% of CSIs are in children aged < 2 years.3 In the largest review of pediatric CSI (75,172 children) by Patel et al, 1098 children were found to have CSI, an overall incidence of 1.5%.1 The mean age of patients with a CSI was 11 years +/- 5 years, and there was a slight predominance of CSI in boys (61%). The vast majority of the injuries (83%) involved the bony structures. Upper CSIs (C1-C4) were seen with equal frequency across all age groups (42% in children aged ≤ 8 years; 58% in children aged > 8 years). Lower CSIs (C5-C7) were most commonly seen in older children (85% in children aged > 8 years). Importantly, 7% of these children had both upper and lower CSIs.
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