Variant 3: Child, younger than 3 years of age, acute cervical spine trauma, Pieretti-Vanmarcke weighted score greater than or equal to 2 to 8 points. Initial imaging. Radiography Cervical Spine In children <3 years of age and in children with delays or other deficits, lack of verbal and cognitive skills represents the main limiting factor for establishing appropriate imaging indications based on the clinical examination. Anatomically, in children <3 years of age the dentocentral synchondrosis is still open and the C3-C7 neural arches have not yet fused [91]. A review of the National Trauma Data Bank showed that 48% of cervical spine injuries in children <3 years of age occurred in the lower cervical spine [54]. Nonetheless, children <3 years of age on average and children in forward-facing car seats can experience odontoid fractures, particularly with rapid deceleration with flexion [91]. Radiographs in conjunction with NEXUS criteria were used to clear 80% of cervical spine injuries in a cohort of 575 patients <3 years of age [42]. Certain clinical criteria have been proposed specifically in children <3 years of age to determine the necessity of imaging [19]. A study comparing cervical spine clearance in unconscious pediatric patients using plain cervical radiographs, flexion-extension under fluoroscopy, CT, and MRI imaging found that flexion-extension fluoroscopy in children with negative cervical radiographs and/or CT imaging is superior to MRI because MRI lacks specificity with regards to differentiating ligamentous edema from rupture [44,45]. CT Cervical Spine CT cervical spine may be of value as a follow-up examination in patients who had radiographs with abnormal or ambiguous findings.
Suspected Spine Trauma Child PCAs. Variant 3: Child, younger than 3 years of age, acute cervical spine trauma, Pieretti-Vanmarcke weighted score greater than or equal to 2 to 8 points. Initial imaging. Radiography Cervical Spine In children <3 years of age and in children with delays or other deficits, lack of verbal and cognitive skills represents the main limiting factor for establishing appropriate imaging indications based on the clinical examination. Anatomically, in children <3 years of age the dentocentral synchondrosis is still open and the C3-C7 neural arches have not yet fused [91]. A review of the National Trauma Data Bank showed that 48% of cervical spine injuries in children <3 years of age occurred in the lower cervical spine [54]. Nonetheless, children <3 years of age on average and children in forward-facing car seats can experience odontoid fractures, particularly with rapid deceleration with flexion [91]. Radiographs in conjunction with NEXUS criteria were used to clear 80% of cervical spine injuries in a cohort of 575 patients <3 years of age [42]. Certain clinical criteria have been proposed specifically in children <3 years of age to determine the necessity of imaging [19]. A study comparing cervical spine clearance in unconscious pediatric patients using plain cervical radiographs, flexion-extension under fluoroscopy, CT, and MRI imaging found that flexion-extension fluoroscopy in children with negative cervical radiographs and/or CT imaging is superior to MRI because MRI lacks specificity with regards to differentiating ligamentous edema from rupture [44,45]. CT Cervical Spine CT cervical spine may be of value as a follow-up examination in patients who had radiographs with abnormal or ambiguous findings.