Occult injuries?
Sure, but let's put it into perspective.
instead of relying on mechanism, let's go with index of suspicion instead.
In an adult, the bones are often fully calcified, so the solid structure absorbs the impact and is damaged accordingly. (similar to a helmet) So in an adult you would expect to see damage to the vertabrae. Now in the adult, if the force is great enough to damage the vertabrae, it may be great enough to not fully be absorbed by it.
In a kid, there is more collagen, which is softer, so you can expect more force transfer from the vertabrae to the only deeper structure, The cord. Making it more likely there is cord damage without vertebral damage. In the child the same force concept as the adult above applies.
In the last trauma conference I was at, one of the keynote speakers presented that up to 30% of spinal cord injuries (SCI) secondary to Fx are not detected by xray, and CT is rapidly becomming the scan of choice.
Damage over time.
It appears in my textbooks of pathology that inflammation is the likely culprit behind occult injury. Understanding such may also mean that the SCI may not be so much occult, than develop over time.
So it may be not as dramatic as "the guy was suddenly paralyzed" after walking around from turning his head whichever way.
Considering that the logic behind steroid administration was to reduce the inflammatory effect of SCI, which didn't have a profound enough effect as fast as was needed, which is why it has been abandoned, it does make a stronger case physiologically for inflammation as the cause over direct injury, primary or secondary.
So while I could agree that there is a such thing as occult spinal injury, if the proper suspicion based on knowledge of pathology, as well as understanding force transfer in various age groups, and finally using the best imaging techniques, the "occult" becomes quite rare.
Also consider that the anterior spinal artery supplies a majority of the spinal cord. It is relatively a very small artery and in the upper cord the vertebral arteries, which are in a very tight compartment, the inflammatory process need only cause occlusion of these arteries to create an ischemic cord injury. It does not have to be profound enough to actually impact the cord.
Based on my anatomical education and experience, I stipulate that the LSB actually can reduce the compartments further, and the inability of the body to compensate for the rise in compartmental pressure can actually expediate or create when none existed prior occlusion of these arteries which are between 3-5mm in diameter.
Many providers have actually witnessed a LSB create enough focal pressure to stop abdominal bleeding for large arteries such as the AA or the illiac arteries. Retroperitoneal pressure to stop an intraperitoneal bleed is a recognized surgical technique and practice.
If yo look at the pressure points on a LSB, the shoulders and basal skull are two of them. There is a narrowing of the spinal compartment and arterial compartments of both. In the most common anatomical variant, the T spine starts at about the level of the scapula, putting the entire C spine in the area of increased pressure.
