Last month, Dr. Richard Anderson from the Pediatric Neurosurgery Center instructed at an advanced pediatric spine meeting, AOSpine, combining neurosurgeons and orthopedic surgeons.  In his lecture he said, “Children are not just miniature adults.  While much of the surgical treatments given to injured adults can be adapted to children, their unique anatomy and function needs special consideration. This is particularly true in the cervical spine.”

Of course, the most obvious difference between an adult’s and a child’s spine is size.  The younger the child, the smaller the spine, but that is not the least of it, says Dr. Anderson.

Pediatric Cervical Spine

The spinal ligaments and joint capsules are more elastic.  The intervertebral disc and it’s annulus are more expansible and allow for more distraction and greater range of motion.  The facet joints are more shallow and they have immature uncinate processes, so the bones are less locked together.  The vertebral bodies are anteriorly wedge-shaped and have not completely formed, so they can also separate more easily from their end plates.  Additionally, this less stable spine has to support an oversized head using underdeveloped neck muscles.

Taking all of this into consideration, with the same forces applied, a child’s neck is likely to be more injured than an adult’s in any given situation.  Dr. Anderson says he routinely sees neck injuries in children that are caused by sports and automobile accidents.  The most common injuries to the subaxial spine in older children are,  facet dislocations, posterior ligament injuries, and wedge compression fractures.  Though perhaps less frequently, these are all types of injuries seen in adults, too, but repairing them in children takes a whole set of adaptations and understanding of the unique spinal anatomy of children.

In his lecture, Anderson reviewed special surgical techniques and hardware that are especially suited to the pediatric spine.  Among these is a technique employing Transarticular Screws that can be used in very young patients in whom options may be limited.

Another consideration with children is the length of follow-up time.   Anderson recommends at least yearly follow-up until the child’s spine has fully matured.

He also urged that not all adult procedures should be adapted to children.  He specifically spoke about the use of the Halo.  The halo is a device that is used outside the body that is actually secured to the skull by screws.  He says that, fortunately, most often a halo is not necessary in children.  Advanced techniques using rigid internal fixation now allow immediate stability of the spine without the use of a halo.

Of particular note at this conference, Dr. Anderson was also one of the instructors in an advanced anatomy course designed to give pediatric neurosurgeons and orthopedic surgeons hands-on experience in how to do spinal surgery safely in children.

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