In adults with SCIWORA, MRI screening did not yield positive findings in a substantial number of patients [98], but examinations in children were able to diagnose cord transection, contusion, and concussion in children <8 years of age with significant prognostic correlations [59]. In addition, children may have cartilaginous injuries that are not visualized on radiographs but are better detected with MRI [24]. It was shown that MRI facilitates the ability to classify thoracolumbar fractures in adults and children to aid in clinical decision making [27,28]. Adequate radiographs miss 35% of sacral fractures; therefore, CT and MRI are superior to radiography in the diagnosis of sacral fractures [29]. CTA Thoracic and Lumbar Spine CTA is not routinely used in the evaluation of children with thoracolumbar trauma. MRA Thoracic and Lumbar Spine MRA is not routinely used in the evaluation of children with thoracolumbar trauma. Arteriography Thoracic and Lumbar Spine Arteriography is not routinely used in the evaluation of children with thoracolumbar trauma. US Thoracic and Lumbar Spine Integrity of the posterior ligamentous complex plays an integral role for stability of the spine, and presence of posterior ligamentous complex injury may indicate more severe damage and change treatment interventions [88]. MRI is the modality of choice for evaluation of the posterior ligamentous complex, but it was shown that its sensitivity and specificity are lower than previously thought [89]. In a prospective study of 18 adult patients with acute thoracolumbar burst fractures, US was used to assess the posterior ligament complex and achieved a sensitivity of 99% and a specificity of 75% (P < . 05) when compared to operative results and preoperative radiographs, CT, and MRI [99]. CT Myelography Thoracic and Lumbar Spine CT myelography is rarely performed and has been largely replaced with MRI.
Suspected Spine Trauma Child PCAs. In adults with SCIWORA, MRI screening did not yield positive findings in a substantial number of patients [98], but examinations in children were able to diagnose cord transection, contusion, and concussion in children <8 years of age with significant prognostic correlations [59]. In addition, children may have cartilaginous injuries that are not visualized on radiographs but are better detected with MRI [24]. It was shown that MRI facilitates the ability to classify thoracolumbar fractures in adults and children to aid in clinical decision making [27,28]. Adequate radiographs miss 35% of sacral fractures; therefore, CT and MRI are superior to radiography in the diagnosis of sacral fractures [29]. CTA Thoracic and Lumbar Spine CTA is not routinely used in the evaluation of children with thoracolumbar trauma. MRA Thoracic and Lumbar Spine MRA is not routinely used in the evaluation of children with thoracolumbar trauma. Arteriography Thoracic and Lumbar Spine Arteriography is not routinely used in the evaluation of children with thoracolumbar trauma. US Thoracic and Lumbar Spine Integrity of the posterior ligamentous complex plays an integral role for stability of the spine, and presence of posterior ligamentous complex injury may indicate more severe damage and change treatment interventions [88]. MRI is the modality of choice for evaluation of the posterior ligamentous complex, but it was shown that its sensitivity and specificity are lower than previously thought [89]. In a prospective study of 18 adult patients with acute thoracolumbar burst fractures, US was used to assess the posterior ligament complex and achieved a sensitivity of 99% and a specificity of 75% (P < . 05) when compared to operative results and preoperative radiographs, CT, and MRI [99]. CT Myelography Thoracic and Lumbar Spine CT myelography is rarely performed and has been largely replaced with MRI.