Recordings from the 2025 Neuro-APP Symposium-Pediatric Cervical Spine Traumatic Injury

Video Transcription

Video Summary

The presentation reviewed how pediatric cervical spine injuries differ from adult injuries and how to evaluate them. Children have proportionally larger heads, developing ossification centers, more flexible ligaments, and greater spinal mobility. These features affect injury patterns and can make normal anatomy look like fractures on imaging. Injury location also varies with age, shifting from the upper cervical spine in young children toward adult-like lower cervical injuries in adolescents.<br /><br />The speaker discussed common mechanisms, including high-speed vehicle crashes, sports-related axial loading, and non-accidental trauma, and emphasized that spinal cord injury may occur even without visible bone or ligament damage. Imaging should balance accurate diagnosis with minimizing radiation: radiographs are often a first step, CT best depicts bone, and MRI evaluates the cord and ligaments.<br /><br />Adult decision rules such as NEXUS do not reliably translate to children. Pediatric algorithms, including the newer PECARN rule, use factors such as GCS, neurological findings, and neck pain to guide imaging, but clinicians should also consider the injury mechanism and individual circumstances. Case studies illustrated both conservative treatment and surgery, with outcomes ranging from full recovery to lifelong disability. The key message was to avoid automatically applying adult practices and to use pediatric-specific expertise and judicious imaging.

Keywords

pediatric cervical spine injuries

pediatric trauma imaging

upper cervical spine

spinal cord injury

PECARN rule

NEXUS criteria

MRI ligaments and cord

high-speed vehicle crashes

non-accidental trauma