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J Am Acad Orthop Surg, Vol 14, No 9, September 2006, 552-564.
© 2006 the American Academy of Orthopaedic Surgeons
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Clearing the Pediatric Cervical Spine Following Injury

Jason David Eubanks, MD, Allison Gilmore, MD, Shay Bess, MD and Daniel R. Cooperman, MD

Dr. Eubanks is Resident, Department of Orthopaedics, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH. Dr. Gilmore is Assistant Professor of Orthopaedics, Department of Orthopaedics, Case Western Reserve University, Rainbow Babies and Children’s Hospital, University Hospitals of Cleveland. Dr. Bess is Assistant Professor of Orthopaedics, Department of Orthopaedics, University of Utah, University Orthopaedic Center, Salt Lake City, UT. Dr. Cooperman is Associate Professor of Orthopaedics, Department of Orthopaedics, Case Western Reserve University, Rainbow Babies and Children’s Hospital, University Hospitals of Cleveland.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Eubanks, Dr. Gilmore, Dr. Bess, and Dr. Cooperman.

Reprint requests: Dr. Gilmore, Department of Orthopaedics, Rainbow Babies and Children’s Hospital, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106.

Injury to the pediatric cervical spine is uncommon; however, a missed or delayed diagnosis can lead to disastrous consequences. Thus, following trauma, clearance of the pediatric cervical spine is important. Problematic issues include child compliance with examination, the complex anatomy of the pediatric cervical spine, lack of agreement on definitive imaging modalities, and the coordination of multiple medical specialties. Expediting clearance of the pediatric cervical spine requires an organized, multidisciplinary approach. In addition to systematic procedures within the emergency department, preventing missed and delayed diagnoses of cervical spine injury can be facilitated by applying a clear methodology for reviewing radiographs in conjunction with the child’s clinical examination. This algorithm considers the adequacy of the images, alignment of the bony and soft-tissue elements, assessment of the cervical intervals, and the presence of abnormal angulation. Together with standard treatment, this protocol facilitates effective and expeditious clearance of the cervical spine.






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Copyright © 2006 by the American Academy of Orthopaedic Surgeons.