Epidemiology of Cervical Spine Trauma in Children

Incidence and Prevalence

Cervical spine injury in children is relatively uncommon.

• Incidence of 1–5 per 100,000 annually: Cervical spine injuries constitute 1–2% of all pediatric fractures, 10–50 cases per million children annually (18,19,23,33,35).  Overall, this results in approximately 1300 pediatric spinal cord injuries per year (24).
• Not as common as head injuries: Spine injuries are 1/20th as common as severe closed head injury in children (8,43).
• 70–80% of spine injuries cervical: Cervical injuries are the most common spine injury in children (70–80% of total) (8).  60% of these occur in the segments from the occiput through C2.
• Neurological deficits more common with lower fractures: 73% of fractures in the lower cervical spine are associated with a neurological deficit as opposed to only 36% in the high cervical area.
• Multiple levels of injury: Multiple-level involvement is more common than in adults.

Age Distribution

• Cervical spine injuries most likely: Upper cervical spine injuries are more common than lower cervical injuries in children of all ages. In children younger than 7 years, the craniocervical region (occiput to C2) is the most commonly affected site (25,44),  however, lower cervical spine injuries, while less common than higher injuries, predominate in older children (13,41).
• Ligament injuries in young children: Ligamentous injury is more common in children younger than 9 years. Young children are more likely to have a spinal Cord Injury Without Radiological Abnormality (SCIWORA)-type injury because of their general laxity and bone immaturity (36,40).
• Bone injuries in older children: Vertebral fractures are more common in older children (10–17 years) who have achieved skeletal maturity.

Sex Predilection

• Males>females: As with all trauma, males are more commonly affected, especially those 10 years of age and older.

Geographic Distribution

• Higher in Asia, Middle East than North American, Europe: Little information exists pertaining specifically to the geographic distribution of childhood cervical trauma, but there is evidence of a wide variation in the incidence of traumatic spinal cord injury according to geography. Higher rates of traumatic spinal cord injury are reported in Asia and the Middle East compared with North America and Europe (16).

Risk Factors

• Motor vehicle accidents: MVAs are the most common cause of pediatric cervical spinal injury, accounting for over half of cases.
• Sports injuries: In adolescents and young adults, sports-related injuries become more prevalent (approximately one quarter of cases) and are more common in males (5)

Relationships to Other Disease States and Syndromes

• Metabolic bone diseases: Patients with metabolic bone disorders, such as osteogenesis imperfecta and osteopetrosis, have an increased risk of vertebral fractures.