Spinal column and cord injuries are relatively uncommon in children, constituting less than 5% of all spinal injuries. Spinal injuries also follow a different pattern in children than in adults. Birth injury, shaking-impact injury, falls and sporting injuries cause most childhood spinal-cord injury (SCI) while motor-vehicle crashes cause most SCI in late adolescence and adulthood.
A child's head is large in proportion to his or her body. Rapid deceleration injuries in children therefore apply greater momentum and torque to the craniocervical junction and upper cervical spine. The spinal ligaments are relatively lax and facet joints are configured horizontally in children, predisposing them to vertebral translation and subluxation. Similarly, the occipital condyles are low in profile and the C1 articular surfaces are relatively flat in children compared to adults. Together, these factors contribute to a high incidence of ligamentous and craniocervical-junction injuries in children. By contrast, spinal-column fractures and subaxial spinal-column injuries are relatively rare in children. Furthermore, pathological analysis reveals that vertebral injuries in children often involve dislocation of the cartilaginous endplate or epiphyseal separation, rather than a true fracture.
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