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198 Craniocerebral and Spinal Trauma
Table 30.6: Evidence-based research.
Title Pediatric spine fractures: a review of 137 hospital
admissions
Authors Carreon LY, Glassman ST, Campbell MJ
Institution Leatherman Spine Center, Louisville, Kentucky, USA
Reference J Spinal Disorders Techniques 2004; 17: 477–482
Problem In children with spinal injury, prevention of further neurologic
damage and deformity, as well as good potential for
recovery, makes timely identification and appropriate
treatment of the injury critical.
Intervention Decompression, fusion, instrumentation.
Comparison/ The 137 patients were divided into three groups for analysis:
control 0–9 years of age (36 patients), 10–14 (49 patients) and
(quality of 15–17 (52 patients). This allowed for comparison of age with
mechanism of injury, injury pattern and level, incidence of
evidence)
cord injury, treatment, and outcomes.
Outcome/ Thirty-six (1%) of 3,685 injured children aged 0–9 years
effect sustained spine injury, compared to 49 (3%) of 1,609 injured
children aged 10–14 years, and 52 (5%) of 921 injured
children aged 15–17 years (p < 0.001). Motor vehicle
accidents were the most common cause of injury across all
ages, followed by falls, sports, and pedestrian accidents.
The incidence of multilevel and noncontiguous injuries in the
different age groups was not significantly different.

Twenty-four patients (19%) had spinal cord injury; 21
(87%) were complete cord injuries, and 3 (13%) were
incomplete. Cord injury was more common in the 0–9 year
age group. Four of five patients with spinal cord injury
without radiographic abnormality (SCIWORA) were in the
0–9 age group and had complete neurologic injuries. Young
children with cervical injuries were more likely to die than
older children. Fifty-three percent had associated injuries.
Eighteen percent underwent decompression, fusion, and
instrumentation. Two patients developed scoliosis. The
complication rate in surgical patients was higher than in
patients treated nonsurgically and in polytrauma patients.
Historical This retrospective clinical case series has presented important
significance/ and useful data from a large series of paediatric patients with
comments spine injuries from a single regional trauma center.

Key Summary Points
Craniocerebral Trauma Spinal Cord Injury
1. Paediatric head injury is common in our environment. 1. Paediatric spinal cord injury presents an enormous challenge,
2. Motor vehicle accidents cause the severest form of injury. not only to the neurosurgeon but to the health and economic
resources of any nation.
3. Child abuse is increasingly becoming recognised as a cause of
paediatric head injury. 2. The care of the spinally disabled child is far from ideal in our
environment.
4. Prompt resuscitation and cervical spine protection are key to 3. Late presentation is the rule in most African settings,
survival.
precluding those who would have benefitted from the institution
5. Scalp bleeding may easily cause anaemia because of small of early treatment modalities.
intravascular volume.
4. Prompt resuscitation and optimal fluid administration limit
6. The postresuscitation GCS score is an important prognostic further cord injury.
factor.
5. More personnel, facilities, and dedicated centres for spinal
7. Intracranial haematomas are aggressively managed. care are in arrears, needing urgent attention.
8. Education and enforcement of legislation on vehicle safety
rules are important in preventive strategies.