From the Guidelines
For a 5-year-old child with a cervical spine ligamentous strain, the recommended duration of cervical spine immobilization in a collar is typically 1-2 weeks, with a gradual reduction in collar use over the subsequent 1-2 weeks, as supported by the most recent and highest quality study available 1. The treatment approach should prioritize initial immobilization to allow healing, while also considering the importance of early mobilization to prevent muscle weakness and stiffness in children.
Key Considerations
- Initial treatment with a soft cervical collar for 1-2 weeks, with continuous wear for the first 3-5 days, then transitioning to daytime wear only 1.
- Gradual reduction in collar use over another 1-2 weeks, wearing it only during more strenuous activities or as needed for comfort.
- Regular follow-up appointments with a pediatric orthopedist or spine specialist at 1-2 week intervals to assess healing and adjust the treatment plan.
- Pain relief with children's acetaminophen or ibuprofen, with dosage based on the child's weight.
- Gentle range of motion exercises as tolerated after the first week, under the guidance of a physical therapist.
Rationale
The approach is based on balancing the need for initial immobilization with the importance of early mobilization to prevent complications, as prolonged immobilization can lead to decreased range of motion and delayed recovery in young patients 1.
Clinical Application
Complete removal of the collar should be based on the child's comfort, resolution of symptoms, and clinical assessment, typically within 2-4 weeks from the injury. Regular reassessment is key to ensuring optimal healing and preventing complications.
From the Research
Cervical Spine Immobilization in Children
The recommended duration of cervical spine (c-spine) immobilization in a collar for a 5-year-old child with a cervical spine ligamentous strain is not explicitly stated in the provided studies. However, some studies provide guidance on the management of pediatric cervical spine injuries.
Management of Pediatric Cervical Spine Injuries
- The study 2 recommends that children younger than age 9 years who have experienced trauma and are nonconversant or have an altered mental status, a neurological deficit, neck pain, or a painful distracting injury, are intoxicated, or have unexplained hypotension, should have anteroposterior and lateral cervical spine x-rays obtained.
- The study 3 presents a case of a 6-year-old boy who was treated nonoperatively for an unstable C2-3 hyperflexion injury with posterior cervical ligamentous disruption and was managed with cervical collar immobilization for 2.5 years.
- The study 4 highlights that children under the age of 8 frequently sustain ligamentous injuries in the upper cervical spine, and that initial management is crucial for long-term outcome.
Immobilization Duration
- While there is no specific recommendation for the duration of cervical spine immobilization in a collar for a 5-year-old child with a cervical spine ligamentous strain, the study 3 suggests that long-term immobilization (2.5 years in the presented case) may be necessary for successful nonoperative treatment of unstable cervical spine injuries in pediatric patients.
- The study 2 recommends consideration of primary operative therapy for isolated ligamentous injuries of the cervical spine with associated deformity, but does not provide guidance on the duration of immobilization for nonoperative treatment.