Spinal injuries in children - key facts and approach
Overview
Spinal injuries in children are uncommon (<2% of paediatric trauma) but can cause major morbidity. Children are more likely than adults to sustain high cervical injuries (C1-C4), and paediatric anatomy and physiology increase the likelihood of ligamentous and spinal‑cord injury without obvious radiographic abnormality.
Management is therefore mechanism‑led, prioritises airway and circulation, and uses a cautious, age‑appropriate imaging strategy (see NICE NG41; NG232).
Epidemiology
- Fewer than 2% of paediatric trauma presentations involve the spine.
- Approximately 80% of paediatric spinal injuries affect the high cervical spine (C1-C4).
- SCIWORA (spinal cord injury without radiological abnormality) is relatively common in young children (most often <8 years) and may represent around 20% of paediatric spinal cord injuries.
Why children’s spines behave differently Anatomical and developmental differences explain the clinical patterns seen in children:
- Large head‑to‑body ratio → greater lever forces on the cervical spine in falls and road traffic collisions.
- Increased ligamentous laxity and more elastic tissues → greater tendency for transient vertebral displacement and cord stretch without bony injury (mechanism for SCIWORA).
- Anteriorly wedged, incompletely ossified vertebral bodies and open growth plates → different injury patterns and occult fractures; normal developmental variants (for example, pseudosubluxation) can mimic injury.
- Less paraspinal muscle mass → reduced dynamic stabilisation.