Dealing with an uncooperative child may lengthen the Normal variants in children <8 years of age, such as pseudosubluxation of C2-C3, absence of lordosis, C3 vertebral wedged appearance, widening of the atlantodental interval, prevertebral soft-tissue thickening, intervertebral widening, and pseudo-Jefferson fracture, can adversely affect the accuracy of CT imaging interpretations [19]. In addition, children <8 years of age may need to be sedated to obtain adequate cross- sectional imaging studies, which carries a low complication risk [19]. Cervical ligamentous injury may remain undetected on CT imaging [19], and CT is not considered an effective modality for evaluation of this type of injury [49]. CT alone performs similarly in the classification of subaxial cervical spine injury as CT and MRI combined [50]. Fat-saturated T2-weighted MRI has been shown to be superior to CT and radiographs in children with craniocervical junction and soft-tissue injury [51]. In cases where MRI is not available or the patient cannot safely undergo MRI, CT performs similarly to MRI in the evaluation of unstable cervical trauma [52]. The spine in children >8 years of age is considered to be similar to the adult spine in that the cervical spine fulcrum is located at the C3-C4 level [12]. In this age group, the lower cervical spine is more commonly injured with trauma and may be difficult to confidently evaluate on radiographs [17]. In a study of unconscious intubated adult patients, lateral radiographs were shown to have a sensitivity of only 51.7% for unstable injuries, while CT showed sensitivity of 98.1%, specificity of 98.8%, and a negative predictive value of 99.7% [30,43]. There is no pediatric scientific literature to support the use of contrast-enhanced CT in the setting of spinal trauma, although IV contrast may be given when whole-body CT is performed to evaluate for other traumatic injuries [53-55].
Suspected Spine Trauma Child PCAs. Dealing with an uncooperative child may lengthen the Normal variants in children <8 years of age, such as pseudosubluxation of C2-C3, absence of lordosis, C3 vertebral wedged appearance, widening of the atlantodental interval, prevertebral soft-tissue thickening, intervertebral widening, and pseudo-Jefferson fracture, can adversely affect the accuracy of CT imaging interpretations [19]. In addition, children <8 years of age may need to be sedated to obtain adequate cross- sectional imaging studies, which carries a low complication risk [19]. Cervical ligamentous injury may remain undetected on CT imaging [19], and CT is not considered an effective modality for evaluation of this type of injury [49]. CT alone performs similarly in the classification of subaxial cervical spine injury as CT and MRI combined [50]. Fat-saturated T2-weighted MRI has been shown to be superior to CT and radiographs in children with craniocervical junction and soft-tissue injury [51]. In cases where MRI is not available or the patient cannot safely undergo MRI, CT performs similarly to MRI in the evaluation of unstable cervical trauma [52]. The spine in children >8 years of age is considered to be similar to the adult spine in that the cervical spine fulcrum is located at the C3-C4 level [12]. In this age group, the lower cervical spine is more commonly injured with trauma and may be difficult to confidently evaluate on radiographs [17]. In a study of unconscious intubated adult patients, lateral radiographs were shown to have a sensitivity of only 51.7% for unstable injuries, while CT showed sensitivity of 98.1%, specificity of 98.8%, and a negative predictive value of 99.7% [30,43]. There is no pediatric scientific literature to support the use of contrast-enhanced CT in the setting of spinal trauma, although IV contrast may be given when whole-body CT is performed to evaluate for other traumatic injuries [53-55].