Pediatric emergency medicine trisk 3614 3614

Vertebral Compression Injuries
Vertebral compression injuries are most frequently caused by axial loading and
hyperflexion. They are suggested by isolated anterior wedging, teardrop fractures,
or burst vertebral bodies ( Fig. 112.29 ). The vertebral bodies should be regular,
cuboid, and consistent between adjacent cervical levels ( Fig. 112.29 ). A
flexion/rotation stress can lead to anterior subluxation of one vertebral body on
another with facet dislocation (“locked” or “jumped” facet) ( Fig. 112.30 ). If the
anterior displacement is less than 50% of the vertebral body width, it is consistent
with a unilateral facet dislocation ( Fig. 112.30 ). More than a 50% anterior
subluxation suggests a bilateral facet dislocation ( Fig. 112.30 ). These injuries are
often accompanied by widened interspinous and interlaminar spaces, anterior soft
tissue swelling, and a narrowed disc space.

Spinal Cord Injury Without Radiographic Abnormality
SCIWORA was initially described as occurring in up to 67% of all children with
cervical cord injuries ( Fig. 112.31 ), and up to 25% of cervical cord injuries in
children younger than 8 years. SCIWORA has been described as mainly occurring
in children younger than 8 years who present with, or develop symptoms
consistent with, cervical cord injuries without any radiographic or tomographic
evidence of bony abnormality. Some authors have recently suggested that the
diagnosis of SCIWORA be applied only to those patients who also do not have
abnormal MRI findings. The original characterization of this syndrome occurred
during a period when MRI was less available and it is important to note there are
distinct differences between patients with and without MRI findings in the setting
of persistent neurologic abnormalities. Regardless, this type of injury is not often
seen in children older than 8 years because the forces necessary to injure the
spinal cord also cause persistent spinal column abnormalities. In older children,
sports-related injuries have been found to have a higher association with
SCIWORA (OR 3.5) as compared to those injured by other mechanisms. The
young child’s elastic spinal column, ligamentous laxity, horizontal facets, and
underdeveloped spinous processes allow the spine to deform beyond physiologic

extremes, injuring the cord, and then reducing spontaneously without any
persistent (radiographic) evidence of bone injury. The causes of the neurologic
compromise can include segmental spinal instability, vascular injury (occlusion,
spasm, and infarction), ligamentous injury, disc impingement, or incomplete
neuronal destruction. A subset of patients has initial transient neurologic
symptoms as previously described, temporarily recover, and then return, on
average, 1 day later with neurologic abnormalities. Therefore, hospitalization,
immobilization, and further radiographic evaluation (MRI) for this group of