US Cervical Spine The value of US has only recently been explored in pediatric cervical spine trauma and is not yet established [87]. 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]. CT Myelography Cervical Spine CT myelography is rarely performed and has been largely replaced with MRI. Exceptional indications may exist for patients with contraindications to MRI and in whom impending cord compression is suspected [90]. Variant 4: Child, younger than 16 years of age, acute thoracolumbar spine trauma. Initial imaging. Radiography Thoracic and Lumbar Spine It was estimated that only 0.6% to 0.9% of all pediatric spinal injuries affect the thoracolumbar supine [93]. There are currently no national guidelines to inform clinicians whether an imaging examination would be beneficial for an individual patient or not [93]. Thoracic and lumbar spine injuries are most commonly seen in children >9 years of age [3]. The clinical diagnosis of thoracolumbar spine fractures in children is frequently difficult because the clinical assessment has only 81% sensitivity and 68% specificity [24]. This argues in favor of screening children with thoracolumbar trauma with radiographs, regardless of clinical symptoms. However, a prospective study in 50 children with thoracolumbar trauma showed that AP and lateral radiographs missed 22% of fractures when compared to MRI [24]. 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]. Sacral fractures account for only 0.16% of all pediatric trauma patients [3].
Suspected Spine Trauma Child PCAs. US Cervical Spine The value of US has only recently been explored in pediatric cervical spine trauma and is not yet established [87]. 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]. CT Myelography Cervical Spine CT myelography is rarely performed and has been largely replaced with MRI. Exceptional indications may exist for patients with contraindications to MRI and in whom impending cord compression is suspected [90]. Variant 4: Child, younger than 16 years of age, acute thoracolumbar spine trauma. Initial imaging. Radiography Thoracic and Lumbar Spine It was estimated that only 0.6% to 0.9% of all pediatric spinal injuries affect the thoracolumbar supine [93]. There are currently no national guidelines to inform clinicians whether an imaging examination would be beneficial for an individual patient or not [93]. Thoracic and lumbar spine injuries are most commonly seen in children >9 years of age [3]. The clinical diagnosis of thoracolumbar spine fractures in children is frequently difficult because the clinical assessment has only 81% sensitivity and 68% specificity [24]. This argues in favor of screening children with thoracolumbar trauma with radiographs, regardless of clinical symptoms. However, a prospective study in 50 children with thoracolumbar trauma showed that AP and lateral radiographs missed 22% of fractures when compared to MRI [24]. 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]. Sacral fractures account for only 0.16% of all pediatric trauma patients [3].