![]() Persistent symptoms: pain, paraesthesia, weakness Examination Other rheumatological, genetic or metabolic conditions.Osteogenesis imperfecta, Achondroplasia.History of conditions known to predispose to CSI Fall >3 metres (or twice the patient’s height).Passenger in an MVC of >60 km/hr, head on collision, rollover, or any accident with a passenger death.Improper restraint in a motor vehicle collision (MVC).Ejection from a vehicle including motorbike.Forced neck hyperflexion (includes low velocity mechanism with high force eg rugby scrum collapse).Axial load to the head (diving, trampoline, falling from height).Thoracic elevation device and in a teenager head elevation device may be used Assessment History In a child under 8 years old this may be achieved by a ![]() Ideally the spine should be kept in a neutral position with the child lying flat. The aim is to minimise movement of the potentially injured spine. identify the cases where expert spinal services are required.clear the cervical spine in children who have sustained blunt trauma.This guideline is designed to assist and empower the clinician to: A validated clinical decision rule for the paediatric population does not exist.Avoid unnecessary immobilisation and imaging where possible Cervical spine assessment and the detection of CSI is difficult.This guideline is for cervical spine assessment only Hard collars have no proven patient benefit and are potentially harmful Foam collars are recommended (if the child will tolerate one) until CSI can be excluded.A senior clinician must assist in the assessment of children with persistent symptoms or who are unable to communicate Most cervical spines can be cleared clinically.Allowing excessive movement of an unstable CSI may lead to severe morbidity.Cervical spine injury (CSI) is uncommon in children.Smooth and continuous and that C2 does not appear "fat" (i.e.See also Trauma - the primary survey Head injury Thoracic elevation device Key Points Make sure the basion-dens space is Make sure the atlantodens interval (ADI or pre-dental space) is Check that the intervertebral spaces are uniform at each level.Surface of the occipital and sphenoid bones) Clivus should be pointing toward the odontoid (the clivus lies at the base of the skull is made from the.Inspect each vertebral body, pedicle, lamina and spinous process from C1 - C7 Check the posterior vertebral line (posterior longitudinal ligament line).Check the anterior vertebral line (anterior longitudinal ligament line).Evaluate the orientation of the epiglottis, hyoid bone, tracheal shadow and check for any foreign bodies.Vertebral body) and < 22 mm in front of C6 (or no more than width of C6 Tissue is < 7 mm in thickness in front of C2 (or < 50% of the width of C2 Make sure you can see all 7 cervical spinous process.The clinician should establish a process or order they follow each time. To the tip of the dens (or odontoid process). The dorsal surface of the clivus and is used to measure the distance of space This is a line drawn from the caudal extension of The tip of the dens should lie less than 4.5 cm above this line. Draw a line from the posterior edge of the hard palate to the caudal end of the occipital curve. Opisthion (posterior aspect of the foramen magnum) cannot be identified on a To recognize the presence of basilar invagination (a craniocervical junctionĪbnormality where the tip of the dens project up into the foramen magnum). If the tip of the dens extends > 3 mm above this line then it helps.The odontoid tip extends above this line. Posterior surface of the hard palate to the tip of the opisthion (posteriorĪspect of the foramen magnum) and is used to measure the distance of how much (normal CT values for men is > 23.7 mm and for women is > 24.2 mm) can be used instead. Tip of the dens is eroded then the Redlund-Johnell and modified Ranawat methods The dens (or odontoid process) should be ~5 mm below this line. Lateral radiograph of the skull or on a sagittal cut from a CT or MRI scan thatĬonnects the posterior and anterior aspects of the foramen magnum. Note: Scroll over or tap on the image to see labels & lines
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