Spinal trauma is relatively uncommon in young children but is more commonly seen in adolescents.19 Cervical spine injuries predominate, although thoracic and lumbar injuries also occur (see lap-belt syndrome, below). Fractures or dislocations not related to birth trauma are very rare in children less than 16 months of age, having yet to be reported in the literature. Motor vehicle crashes are the most common reason for spinal injury, followed by falls and sports events. In young children, falls predominate and, in older children, motor vehicle crashes predominate. Due to increased flexibility of the spine and spinal column in younger children, fractures and dislocations rarely occur with minor trauma, and spinal cord injury without radiographic abnormality (SCIWORA) can occur. Adolescents more commonly have fracture patterns similar to those of adults. Also, 50 percent of spinal injuries and 67 percent of cervical spinal injuries in children under the age of 12 occur between the occiput and C2. By comparison, adolescents and adults more commonly experience lower cervical spine injuries.19 Younger children also less frequently have thoracic or lumbar injuries. Signs and symptoms of spinal cord injury are nearly always evident in the pediatric population when present following injury. Part of the reason for this pattern of injury is that an immature child's spine and an adult's spine have several differences ( Table.. ..2.4.4z5.).
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