In a retrospective study of 89 patients, only 5% sacral fractures were found, all of which were Denis zone 1 fractures [3], which are located lateral to the neural elements and commonly involve the sacral alae [29]. Another study reported that adequate radiographs miss 35% of sacral fractures and, therefore, CT and MRI are superior to radiography in the diagnosis of sacral fractures [29]. CT Thoracic and Lumbar Spine CT spine may be of value as a follow-up examination in patients who had radiographs with abnormal or ambiguous findings. There are not sufficient data to support the routine use of MDCT without IV contrast in the clearance of pediatric blunt spinal trauma. As shown in adults, it may be useful to screen for thoracolumbar fractures by using reconstructed spine images from chest, abdomen, and pelvis MDCT, when available [94-96]. Adequate radiographs miss 35% of sacral fractures; therefore, CT and MRI are superior to radiography in the diagnosis of sacral fractures [29]. A recent study in adults showed that CT can identify posterior ligament complex injuries with satisfactory reliability, which can be useful for the classification of thoracolumbar fractures [97]. MRI Thoracic and Lumbar Spine MRI of the spine may be of value as a follow-up examination in patients who have an abnormal neurological examination. MRI without IV contrast has become the modality of choice for imaging of children with thoracolumbar trauma and is especially useful in detecting injuries that require surgical intervention and that may be missed on CT, such as epidural hematoma or traumatic disk herniation [93]. SCIWORA is more common in children <8 years of age and mostly affects the cervical spine, but thoracic spine involvement is seen in 13% of cases [93]. It has been reported that SCIWORA was found in up to 38% of pediatric patients with myelopathy and no fracture or ligamentous injury on radiographs or CT [91].
Suspected Spine Trauma Child PCAs. In a retrospective study of 89 patients, only 5% sacral fractures were found, all of which were Denis zone 1 fractures [3], which are located lateral to the neural elements and commonly involve the sacral alae [29]. Another study reported that adequate radiographs miss 35% of sacral fractures and, therefore, CT and MRI are superior to radiography in the diagnosis of sacral fractures [29]. CT Thoracic and Lumbar Spine CT spine may be of value as a follow-up examination in patients who had radiographs with abnormal or ambiguous findings. There are not sufficient data to support the routine use of MDCT without IV contrast in the clearance of pediatric blunt spinal trauma. As shown in adults, it may be useful to screen for thoracolumbar fractures by using reconstructed spine images from chest, abdomen, and pelvis MDCT, when available [94-96]. Adequate radiographs miss 35% of sacral fractures; therefore, CT and MRI are superior to radiography in the diagnosis of sacral fractures [29]. A recent study in adults showed that CT can identify posterior ligament complex injuries with satisfactory reliability, which can be useful for the classification of thoracolumbar fractures [97]. MRI Thoracic and Lumbar Spine MRI of the spine may be of value as a follow-up examination in patients who have an abnormal neurological examination. MRI without IV contrast has become the modality of choice for imaging of children with thoracolumbar trauma and is especially useful in detecting injuries that require surgical intervention and that may be missed on CT, such as epidural hematoma or traumatic disk herniation [93]. SCIWORA is more common in children <8 years of age and mostly affects the cervical spine, but thoracic spine involvement is seen in 13% of cases [93]. It has been reported that SCIWORA was found in up to 38% of pediatric patients with myelopathy and no fracture or ligamentous injury on radiographs or CT [91].