Cervical Spine Injury Assessment in Pediatric Populations

Paediatric cervical spine injuries are uncommon but carry a high risk of permanent neurological impairment if not identified and managed promptly. The distinctive anatomical features of children – including relative head size, ligamentous laxity and incomplete ossification – render standard adult assessment strategies less reliable. Clinical evaluation begins with a careful neurological examination and assessment of pain, midline tenderness and range of motion. Given the imperative to minimise ionising radiation, decision rules such as the NEXUS criteria and the Canadian C-Spine Rule guide selective use of imaging. Conventional radiography remains the initial modality for many low-risk presentations, while computed tomography (CT) offers rapid and detailed osseous assessment in higher-risk scenarios. Magnetic resonance imaging (MRI) has emerged as a valuable adjunct for soft-tissue visualisation and detection of spinal cord injury without radiological abnormality. Recent advances include optimisation of paediatric-tailored imaging protocols, application of machine-learning tools to standard radiographs and pictorial reviews to aid emergency physicians in recognising subtle findings. International efforts are under way to harmonise clinical pathways, reduce unnecessary imaging, and ensure early involvement of multidisciplinary teams for conservative or surgical stabilisation. Future directions focus on refining risk stratification through age-specific algorithms, leveraging artificial intelligence for real-time triage and expanding access to MRI in acute settings.

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Cervical Spine Injury Assessment in Pediatric Populations publication trend

The graph below shows the total number of articles in cervical spine injury assessment in pediatric populations across all publications each year (not limited to Nature Index journals).

Technical terms

SCIWORA (Spinal Cord Injury Without Radiological Abnormality): Traumatic spinal cord dysfunction in the absence of fracture or dislocation on conventional imaging.

NEXUS criteria: A set of five clinical findings used to identify low-risk patients in whom cervical spine imaging may be safely omitted.

Canadian C-Spine Rule: A decision instrument that combines high- and low-risk factors with range-of-motion assessment to determine the need for radiography after blunt neck trauma.

References

1. Diagnostic Excellence in Pediatric Spine Imaging: Using Contextualized Imaging Protocols. Diagnostics (2023).
2. Emergency MRI in Spine Trauma of Children and Adolescents—A Pictorial Review. Children (2023).
3. Diagnostic accuracy of deep learning for evaluation of C-spine injury from lateral neck radiographs. Heliyon (2022).