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Stabilization of Cervical Spine Trauma in Children

This page was last updated on April 8th, 2024

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