- Published guidelines and local protocols: Published guidelines (56) and institution-based guidelines should be used to direct initial evaluation and investigations.
- Nonoperative management: Many cervical spine injuries in children can be managed nonoperatively with orthotic immobilization, analgesia, and serial imaging.
- Halo-vests usage: Halo-vests provide the most effective means of external cervical immobilization. In young children (<5 years), 8–10 pins sites may be required. Halo-vest immobilization can be used in addition to surgical fusion in young children where rigid fixation is not feasible.
- Alignment: Restoration of alignment and maintenance of stability and preservation of neurological function are the goals of treatment.
- Rare need for fusion: Surgical fusions should be kept to a minimum number of levels required to achieve the treatment goals to reduce the problems of late adjacent-level disease.
- Sublaminar wires in young patients: Sublaminar cables provide a useful and effective means of securing rods or grafts in young children where lateral mass or pedicles are insufficient to hold screws (57)..