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Review of Upper Spinal Disorders in Children

Posted on: 12/17/2008
While lower back pain and disorders are not uncommon among children, especially athletes, upper cervical spine (extreme upper back) disorder are quite rare.

A baby's back is only starting to harden properly during the first year and continues to do so until the child is about six years old. After that, there is still some progress in the back for another year or so, finishing completely as the child hits his or her teen years.

Upper cervical spine disorders can be one of many and are often a "one-of" type of thing, not associated with any other type of illness or birth defect. However, it's not unusual for there to be more than one anomaly (defect) so if one is found, physicians should look for more.

The diagnosis of upper spinal disorders needs x-rays, as well as more advanced imaging, such as magnetic resonance imaging (MRI). Congenital anomalies, ones that children are born with, can be many.

The first cervical vetebral anomalies are at the top of the neck where it meets the skull. The full verbetrae (bone) may not completely ossify (harden) up until a child is four years old but in some children, like those with Down's syndrome, this is an anomaly. Congential fusions occur when the first cervical vertebrae fuses with the base of the skull, something it's not supposed to do. In about half of cases, up to 70 percent, if the first vertebrae is fused, it's most likely the second and third vertebrae are too. This problem results in instability of the neck and some neurologic (nerve) symptoms that may only develop when the person is in their twenties or thirties.

Os odontoideum occurs when the dens (tooth-like projection from the second vertebra in the neck) isn't connected to the vertebrae as it should be. It may be off to the side or displaced completely. This could result in instability of the neck as well.

Actual instability of the neck can be caused by several issues, as well as the ligaments not being strong enough to hold the neck up. Because it's not taut, it could also put pressure on the nerves alongside the neck. Torticollis is painful condition that keeps you from turning your head to one side or tilt it down or up. This can be caused by a congenital problem, infection, and different syndromes.

Finally, trauma is also a cause of neck instability but this is rare. Trauma could be from the birth, accidental injury, or falls. These can result in dislocations and/or fractures and require treatment. A Halo brace, the ring that is fit around a patient's head and connected to a brace, is one way to correct some of the upper cervical spine disorders

The authors of this article concluded that the upper cervical spine injury is not common among children but diagnosis and treatment of the ones that are present is very important to prevent further injury.

References:
Michelle S. Caird and Karl F. Bowman Jr. Upper cervical spine disorders in children. In Current Orthopaedic Practice November 2008. Vol. 19. No. 6. Pp. 634-639.

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