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Pediatric Cervical Spine InjuryAka: SCIWORA

See Also
1. Cervical Spine Injury
Definition
1. SCIWORA (Spinal Cord Injury w/o Radiographic Abnormal.)
Epidemiology
1. Important cause of pediatric spinal cord injury
2. Responsible for large number pre-hospital deaths
Mechanism
1. C-Spine Levels most commonly involved
  1. Infants and Toddlers
    1. Atlanto-occipital joints (C1)
    2. Atlantoaxial joints (C1-C2)
  2. School Age Children
    1. Lower cervical spine (C5-C7)
2. Cervical Spine Injury Types
  1. Anatomic: bony vertebral abnormality on XRAY)
  2. Functional: SCIWORA
    1. Increased elasticity of c-spine ligaments
3. Pseudosubluxation
Approach
1. Assume Cervical Spine Injury present
  1. All children with multiple injuries
2. Falls less than 5 feet rarely cause C-Spine Injury
  1. XRay not needed if C-Spine ROM normal and no pain
  2. Schwartz (1997) Ann Emerg Med 30:249
3. XRay can not rule out Pediatric C-Spine Injury
4. Maintain C-Spine control until full clinical evaluation

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.