Which statement is true regarding the prevalence of upper cervical injuries in neonatal spinal trauma?

• A. Upper cervical injuries are more common than lower cervical injuries
• B. Thoracic injuries are more common than cervical injuries
• C. Lumbar injuries are more common than thoracic
• D. Sacral injuries are more common than lumbar

Answer: (A)

In neonates, injuries to the upper cervical spine are more common than injuries to the lower cervical spine because the head is proportionally large and the neck is still weak and highly flexible. The atlantooccipital and atlantoaxial joints bear the most stress during trauma in this age group, due to the head’s weight and the ligaments and muscles being relatively lax. This makes upper cervical injuries the predominant pattern in neonatal spinal trauma, whereas injuries in the lower cervical, thoracic, lumbar, and sacral regions are less frequent at this age. So the statement that upper cervical injuries are more common than lower cervical injuries best reflects neonatal injury patterns.