DIAGNOSIS AND TREATMENT OF ACUTE DOUBLE CERVICAL SPINAL CORD INJURIES IN SCHOOL-AGE CHILDREN

Аннотация

Acute double cervical spinal cord injuries (DSCI) in school-age children are rare but posesignificant challenges due to the uniqueanatomical and physiological characteristics of the pediatric cervical spine. Prompt diagnosis and individualized treatment are crucial for optimizing outcomes. This article reviews current diagnostic approaches, treatment modalities, andprognosticfactors associated with DSCIin thisage group. Keywords:Pediatric cervical spine trauma, double cervical spinal cord injury, school-age children, diagnosis, treatment, neurological recovery INTRODUCTION: Cervical spinal cord injuries (SCI) in the pediatric population, particularly among school-age children (6–12 years), represent a rare but highly serious subset of traumatic injuries. Although the overall incidence is lower than in adults, the consequences of such injuries can be devastating, including permanent neurological impairment, long-term disability, or even death. Among these cases, acute double cervical spinal cord injuries (DSCI)—where trauma affects two separate cervical spine levels—are exceedingly uncommon and pose unique diagnostic and therapeutic challenges. The cervical spine in children is anatomically and biomechanically distinct from that of adults. Factors such as increased ligamentous laxity, horizontally oriented facet joints, and underdeveloped musculature contribute to a higher susceptibility to multi-level and more complex injuries. Additionally, the larger head-to-body ratio in younger children results in greater torque forces on the neck during high-impact trauma such as motor vehicle accidents, sports injuries, or falls. These anatomical features also complicate the interpretation of imaging and the decision-making process for treatment. Due to the rarity and complexity of DSCI, there is limited literature focused specifically on this injury pattern in school-age children. Management must be prompt and carefully planned, often requiring a multidisciplinary approach involving emergency physicians, pediatricneurosurgeons ororthopedic spinesurgeons, radiologists, and rehabilitation specialists. Delayed or incorrect diagnosis may lead to irreversible damage, while inappropriate treatment can result in spinal instability or complications related to growth and development. This paper aims to review the current understanding of acute double cervical spinal cord injuries in school- age children, including diagnostic strategies, treatment options, and clinical outcomes. By synthesizing existing evidence and clinical practices, the article seeks to inform and improve themanagement protocols forthese rare but high-risk pediatric injuries. LITERATUREREVIEW 424 INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCHERS ISSN:3030-332X Impact factor: 8,293 Volume 11,issue2,May 2025 https://wordlyknowledge.uz/index.php/IJSR worldly knowledge Index: googlescholar, research gate, research bib, zenodo,open aire. https://scholar.google.com/scholar?hl=ru&as_sdt=0%2C5&q=wosjournals.com&btnG https://www.researchgate.net/profile/Worldly-Knowledge https://journalseeker.researchbib.com/view/issn/3030-332X Pediatric cervical spine injuries are relatively rare, accounting for approximately 1–2% of all pediatric spinal injuries. However, when they occur, they can result in significant morbidity and long-term complications [1]. The incidence and injury mechanisms differ by age group. Younger children typically sustain upper cervical injuries (C1–C2) due to increased ligamentous laxity and incomplete vertebral ossification, while older children more frequently experience lower cervical injuries (C3–C7) related to high-energy trauma such as motor vehicle accidents and sports injuries [2]. Children's unique anatomical features—such as a proportionally larger head, horizontally oriented facet joints, and more elastic spinal columns— make them more susceptible to multi-level injuries and spinal cord injury without radiographic abnormalities (SCIWORA), especially intheupper cervical region [3]. Diagnosis begins with a clinical assessment, including a detailed history and neurological examination, followed by imaging. While plain radiographs are often the initial imaging modality, their sensitivity in detecting complex or subtle cervical injuries in children is limited [4]. CT scans offer superior evaluation of bony structures and are commonly used in trauma settings for detecting fractures or dislocations [5]. MRI plays a critical role in identifying soft tissue injuries, including spinal cord compression, ligamentous injuries, and intervertebral disc damage—especially in cases of unexplained neurological deficits [6]. In cases of suspected SCIWORA or double-level injuries, MRI is essential to confirm diagnosis and guide treatment decisions [7]. Management depends on the severity, stability, and neurological status. Stable injuries with no neurological involvement can often be managed conservatively with immobilization (e.g., cervical collar or halo vest)