UMEM Educational Pearls

Category: Pediatrics

Title: Evaluating the Cervical Spine in Pediatric Trauma

Keywords: cervical spine, trauma, pediatrics (PubMed Search)

Posted: 9/7/2012 by Lauren Rice, MD
Click here to contact Lauren Rice, MD



Ligamentous laxity is increased in children and ligamentous injury is more common than fractures.

If fractures occur, they are more likely to be in the upper cervical spine in infants and the lower cervical spine in older children.

Pseudosubluxation:  physiologic subluxation between C2-3 and C3-4 may exist until age 16 years



Screening Assessment/Clearance for Verbal Children

-Midline C-spine tenderness?

-Pain with active motion?

-Altered level of alertness?

-Evidence of intoxication?

-Focal neurological deficit?

-Distracting painful injury?

-High impact injury?


Screening Assessment/Clearance for Pre-Verbal Children

-Neurological assessment of basic reflexes

-Response to painful stimuli

-Equal movements of all extremities

-Response to sound (eye tracking)

-Extremity strength and resistance

-Palpate posterior C-spine (observe for facial grimace)

-Feel for step-offs, deformities

-Verify full range of motion of neck (may need to be creative) 

-Repeat neurological assessment 


If concern arises on screening assessment, keep child in hard cervical collar and image (may start with x-ray and progress to CT if still concerned and x-rays negative).

If imaging negative, but persistent suspicion based on neurological deficits consider SCIWORA (Spinal Cord Injury WithOut Radiographic Abnormality) which exists in up to 50% of children with cervical cord injury, and may require MRI to further identify injury.