Emergent Imaging of Pediatric Cervical Spine Trauma

Abstract

Owing to physiologic and biomechanical differences, the incidence, patterns, distributions, and mechanisms of spinal injury in children differ from those in adults. Furthermore, evaluation of the spine can be complicated by synchondroses, developmental and/or anatomic variants, and interpretative pitfalls that are unique to the developing spine of a child. Although the incidence of spinal injury is lower in children, the sequelae are more severe, with higher morbidity and mortality. Mechanistic differences, notably nonaccidental trauma in infants and toddlers; physiologic differences, notably a disproportionately large head relative to body size and ligamentous and soft-tissue laxity; and the propensity of these injuries to occur at higher spinal levels (craniocervical junction to C3) are contributing factors. In addition, imaging recommendations for children are different. Assessment of spinal alignment and adjacent soft tissues, particularly at the craniocervical junction, with a low threshold for performing MRI, is key to diagnosing these serious injuries. The patterns of common pediatric cervical spine injuries, including craniocervical junction injury and spinal cord injury without a correlating radiographic abnormality, are reviewed. © RSNA, 2019 • radiographics.rsna.org

Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT)

“…It is well known that a disproportionately larger head in children is supported by weaker and more lax cervical muscle and ligaments than in adults [ 64 ]. What appears peculiar is the topical distribution of spinal injuries, which seems to be age-related.…”

Rare and Unique Case of Midline Anterior Arch of Atlas Non-formation Mimicking Jefferson Type 1 Fracture

“…The reported incidence of 1.0-1.3% is far less than half of that of the adult population [1]. However, the sequelae in children are more disastrous with reported mortality to be around 40-50% and 60% of those suffering from permanent neurological deficits [1,2]. Hence, the presence of cervical spine injuries in children may raise alarm and place the treating team in duress, more so if it involves the complex and challenging craniovertebral junction which has an even higher morbidity and mortality rate.…”

“…Cervical spine injuries in the paediatric age group are exceedingly rare. The reported incidence of 1.0-1.3% is far less than half of that of the adult population [1]. However, the sequelae in children are more disastrous with reported mortality to be around 40-50% and 60% of those suffering from permanent neurological deficits [1,2].…”

Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations

“…44 In the absence of such variables, radiographs should be indicated within the first 60 minutes, if a harmless examination of neck movement cannot be conducted or a dangerous mechanism of trauma is present. 45 There is a significant discrepancy in the average radiation dose for paediatric cervical spine imaging. Hence, there is a need for standardization in terms of radiation dosage for CT exams.…”

“…(3) Magnetic resonance imaging Magnetic resonance imaging (MRI) is considered one of the most informative imaging modalities and enables examination of ligamentous trauma that could be overlooked on CT imaging. 45,46 Gargas et al 47 (n = 173) analysed the findings on MRI after a normal CT scan in paediatric CSIs. He found significant injuries on MRI in 17% of patients, of which 2.9% needed stabilization.…”