Normal variants in children <3 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 <3 years of age may need to be sedated to obtain adequate cross- sectional imaging studies, which carries a low complication risk [19]. 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]. MRI Cervical Spine MRI of cervical spine may be of value as a follow-up examination in patients who have an abnormal neurological examination. The best imaging modality for evaluation of newborn spinal cord injury secondary to cervical spine trauma is MRI [92]. Neonatal spinal cord injury is a rare condition with an estimated incidence of 1 in 80,000 live births. MRI was shown to be superior to CT and radiographs in children with craniocervical junction injuries, including soft-tissue injuries that are best seen on fat-saturated T2 sequences [51]. CTA Neck There are currently no sufficient reports regarding outcomes of vascular imaging in children with spinal trauma. Cervical vascular injury in pediatric blunt trauma can be seen in 11.5% of pediatric patients [68]. CTA has been validated against DSA for imaging of cerebrovascular injury in adults, but DSA remains the reference standard [68]. When compared to DSA, CTA has the benefit of being less time intensive, having a lower risk of iatrogenic injury, and having fewer complications than those associated with DSA (such as stroke or death, arterial dissection, and vasospasm) [68,78].
Suspected Spine Trauma Child PCAs. Normal variants in children <3 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 <3 years of age may need to be sedated to obtain adequate cross- sectional imaging studies, which carries a low complication risk [19]. 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]. MRI Cervical Spine MRI of cervical spine may be of value as a follow-up examination in patients who have an abnormal neurological examination. The best imaging modality for evaluation of newborn spinal cord injury secondary to cervical spine trauma is MRI [92]. Neonatal spinal cord injury is a rare condition with an estimated incidence of 1 in 80,000 live births. MRI was shown to be superior to CT and radiographs in children with craniocervical junction injuries, including soft-tissue injuries that are best seen on fat-saturated T2 sequences [51]. CTA Neck There are currently no sufficient reports regarding outcomes of vascular imaging in children with spinal trauma. Cervical vascular injury in pediatric blunt trauma can be seen in 11.5% of pediatric patients [68]. CTA has been validated against DSA for imaging of cerebrovascular injury in adults, but DSA remains the reference standard [68]. When compared to DSA, CTA has the benefit of being less time intensive, having a lower risk of iatrogenic injury, and having fewer complications than those associated with DSA (such as stroke or death, arterial dissection, and vasospasm) [68,78].