Because of the technical difficulties and anatomical limitations of children, external immobilization may be preferable to internal fixation.
Rigid Cervical Collar
- Not acceptable for unstable injuries: Atlanto-occipital dislocations and other unstable cervical spine injures cannot be managed with rigid cervical collars.
- Appropriate for initial immobilization in most injuries: A rigid cervical collar, such as the Aspen, Philadelphia, or Miami J collar, is a good initial measure for stabilizing suspected cervical instability after trauma. It is also an acceptable definitive treatment for selected stable cervical spine fractures.
- Difficulty maintaining neutral position (8,47): In one study, 60% of children were shown to have >5 degrees of angulation from neutral position while in a rigid cervical collar (10).The Cobb angle varied between -27 and +27 degrees in the pediatric population despite appropriate collar application.
Rigid cervical collar: Collars must be “snug” fitting with appropriate support beneath the chin and occiput.
- Most rigid fixation: A halo is the most rigid form of external cervical fixation available. Unfortunately, it still allows some motion in the sagittal and coronal planes, especially in younger patients.
- Use more pins in young children: When treating children younger than 6 years of age, 8 pins (with less torque) instead of the usual 4 should be considered.
- Immobilization remains treatment preference for many stable injuries: Although advanced spinal instrumentation techniques have been increasingly used in pediatric practice for unstable injuries, immobilization is still recommended as a treatment preference for many stable injuries. The rigidity of halo
Halo-body orthosis: Halo-body vests can be used in children as young as 1 year. In young children additional cranial pins are recommended.
Rigid Spine Orthotics—SOMI, CTLSO, Minerva braces
- Maintain cervical and thoracic spine alignment: The SOMI[RA1] , CTLSO, and Minerva braces are useful for maintaining cervical and thoracic alignment. They are often better tolerated than halo fixation.
- Custom Minerva brace for very young: The Minerva brace can be useful in extremely young children and infants when fabricated specifically for the patient. The disadvantage of this treatment is it requires frequent re-fitting by a qualified orthotist.