Cite

Copy

Tap on and choose 'Add to Home Screen' to create a shortcut app

Tap on and choose 'Add to Home Screen/Install App' to create a shortcut app

Stabilization of Cervical Spine Trauma in Children

This page was last updated on February 24th, 2019

Because of the technical difficulties and anatomical limitations of children, external immobilization may be preferable to internal fixation.

Rigid Cervical Collar

  • Not acceptable for unstable injuries: Atlanto-occipital dislocations and other unstable cervical spine injures cannot be managed with rigid cervical collars.
  • Appropriate for initial immobilization in most injuries: A rigid cervical collar, such as the Aspen, Philadelphia, or Miami J collar, is a good initial measure for stabilizing suspected cervical instability after trauma. It is also an acceptable definitive treatment for selected stable cervical spine fractures.
  • Difficulty maintaining neutral position (8,47): In one study, 60% of children were shown to have >5 degrees of angulation from neutral position while in a rigid cervical collar (10).The Cobb angle varied between -27 and +27 degrees in the pediatric population despite appropriate collar application.

Rigid cervical collar: Collars must be “snug” fitting with appropriate support beneath the chin and occiput.

Halo Fixation

  • Most rigid fixation: A halo is the most rigid form of external cervical fixation available. Unfortunately, it still allows some motion in the sagittal and coronal planes, especially in younger patients.
  • Use more pins in young children: When treating children younger than 6 years of age, 8 pins (with less torque) instead of the usual 4 should be considered.
  • Immobilization remains treatment preference for many stable injuries: Although advanced spinal instrumentation techniques have been increasingly used in pediatric practice for unstable injuries, immobilization is still recommended as a treatment preference for many stable injuries. The rigidity of halo

Halo-body orthosis: Halo-body vests can be used in children as young as 1 year. In young children additional cranial pins are recommended.

Rigid Spine Orthotics—SOMI, CTLSO, Minerva braces

  • Maintain cervical and thoracic spine alignment: The SOMI[RA1] , CTLSO, and Minerva braces are useful for maintaining cervical and thoracic alignment. They are often better tolerated than halo fixation.
  • Custom Minerva brace for very young: The Minerva brace can be useful in extremely young children and infants when fabricated specifically for the patient. The disadvantage of this treatment is it requires frequent re-fitting by a qualified orthotist.

SOMI Brace

CTLSO Brace

MINERVA Brace

Your donations keep us going

The ISPN Guide is free to use, but we rely on donations to fund our ongoing work and to maintain more than a thousand pages of information created to disseminate the most up-to-date knowledge in the field of paediatric neurosurgery.

By making a donation to The ISPN Guide you are also indirectly helping the many thousands of children around the world whose treatment depends on well-informed surgeons.

Please consider making a donation today.

Use the app

The ISPN Guide can be used as a standalone app, both on mobile devices and desktop computers. It’s quick and easy to use.

Fully featured

Free registration grants you full access to The Guide and host of featured designed to help further your own education.

Stay updated

The ISPN Guide continues to expand both in breadth and depth. Join our mailing list to stay up-to-date with our progress.