Why is the Pediatric Upper Cervical Spine Susceptible to Spinal Injury?
Injuries to the pediatric spine occur most commonly in the upper neck. The pediatric spine has particular characteristics that make it vulnerable to one of those occurrences, a vertebral subluxation. Factors inherent to the structure and function contribute to this susceptibility. Let’s explore a few commonalities present in all demographics and then highlight some that are unique to the pediatric population.
The spinal cord is the main conduit for nerve information between the brain and the body. In the upper cervical spine, the spinal cord is the largest in diameter due to the high concentration of nerve fibers.
The spinal canal is the passageway for the spinal cord. It is made up of bones, ligaments and other connective tissues that surround and protect the spinal cord. The spinal canal diameter is the smallest in the upper cervical spine.
Spinal mobility is greatest in the upper cervical spine. This allows us to interact with our environment in dynamic ways. This also makes the upper cervical spine the least stable area of the spine.
To summarize thus far, the spinal cord diameter is the largest and the spinal canal diameter is the smallest. Also, the upper cervical spine has the greatest mobility, but also the most instability.
This means that the bones of the upper cervical spine are closer to the spinal cord compared to anywhere else in the spinal column. Furthermore, the top bones of the spine are in proximity to a significant concentration of nerve fibers. And finally, the availability of movement in this region contributes to the potential of instability as well. These factors alone are a recipe for injury if given the right circumstances. Now, let’s add in factors specific to the pediatric spine.
Infants have large head-to-body ratios. This makes the fulcrum of motion in the cervical spine occur at the C2-C3 joint. In adults, the fulcrum is normally at the C5-C6 joint.
Infants also have weak, underdeveloped neck muscles and lax ligaments. This encourages hypermobility in the spine, especially the upper neck.
Furthermore, the joints and spinous processes of the pediatric spine are not yet fully developed, making them shallow and angled. This makes the spine susceptible to anterior wedging of the vertebral bodies. All these factors put high torque and shear forces on the upper cervical spine and can result in a vertebral subluxation.
A vertebral subluxation causes the top bones of the spine to encroach near the spinal cord and impinge on nerves. This adds pressure to nerve tissue and interferes with its function. When nerve function is interfered with, it creates nerve disruption. And nerve disruption negatively effects how messages about muscle movement, organ regulation, sensation and perception are controlled. Health and homeostasis is altered.
- Jarek Esarco, DC, CACCP
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