Paediatric Spinal Trauma & Fractures
Anatomy
Development
- developing atlas has three ossification centers, one centrum(body) & two arches, the arches fuse posteriorly by 3 years of age & the synchondrosis between the arches & the centrum typically fuse by 7 years of age
- axis has 5 ossificaiton centers – two in the odointoid – generally fused by birth, one centrum & two arches
- Odontoid fuses with the centrum & likewise the arches with the centrum at 3-6 years of age , hence should not see a synchondrosis between the odointoid & centrum greater than 6 years of age
- summit ossification center of the odontiod appears between 3-6 years & fuses by 12 years of age – persistance = ossiculum terminale
- Lower cervical vertebrae form from 3 ossification centers, the posterior arch fuses at about 2-3 years & the central synchondrosis at 3-6 years
- Vertebral body is wedged shaped until approximately 7 years old when it squares off
- Of note the injury at the subaxial level will occur through the weaker provisional zone of calcification
- Apophyseal rings appear by late childhood & disappear by 20’s
Unique features of the Paediatric Cervial Spine
- Disproportionately large head
- Increased physiologic motion – relative ligamentous laxity, shallow horizontal facets, muscle weakness, incomplete vertebral ossification (wedge)
- These features serve to raise the fulcrum higher to the upper c-spine
- Falls & MVA dominate & as children get older sporting activities also occur
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