ABSTRACT
Immobilization of the cervical spine at the scene of injury represents standard of care in prehospital management of pediatric trauma patients. Exclusion of injury after formal trauma evaluation and the decision to discontinue immobilization can be straightforward in awake and asymptomatic patients but challenging in preverbal or very young children, patients with severe traumatic brain injury (TBI), intoxicated patients, or patients with otherwise impaired consciousness. This chapter discusses the unique aspects of pediatric cervical spine anatomy, injury patterns, and evaluation. It reviews current practice as well as a summary derived from published protocols providing guidance for cervical spine clearance in children. Any persistent pain or neurologic deficit should prompt evaluation for spinal cord injury without radiographic abnormality (SCIWORA). Most protocols recommend MRI of the cervical spine for this purpose rather than flexion-extension films. Cervical spine immobilization should be continued throughout this process until formal clearance of the cervical spine is obtained.
