DETECTION OF PEDIATRIC CERVICAL SPINE INJURY

Abstract OBJECTIVE In evaluating the pediatric cervical spine for injury, the use of adult protocols without sufficient sensitivity to pediatric injury patterns may lead to excessive radiation doses. Data on injury location and means of detection can inform pediatric-specific guideline development. METHODS We retrospectively identified pediatric patients with codes from the International Classification of Diseases, 9th Revision, for cervical spine injury treated between 1980 and 2000. Collected data included physical findings, radiographic means of detection, and location of injury. Sensitivity of plain x-rays and diagnostic yield from additional radiographic studies were calculated. RESULTS Of 239 patients, 190 had true injuries and adequate medical records; of these, 187 had adequate radiology records. Patients without radiographic abnormality were excluded. In 34 children younger than 8 years, National Emergency X-Radiography Utilization Study criteria missed two injuries (sensitivity, 94%), with 76% of injuries occurring from occiput–C2. In 158 children older than 8 years, National Emergency X-Radiography Utilization Study criteria identified all injured patients (sensitivity, 100%), with 25% of injuries occurring from occiput–C2. For children younger than 8 years, plain-film sensitivity was 75% and combination plain-film/occiput–C3 computed tomographic scan had a sensitivity of 94%, whereas combination plain-film and flexion-extension views had 81% sensitivity. In patients older than 8 years, the sensitivities were 93%, 97%, and 94%, respectively. CONCLUSION Younger children tend to have more rostral (occiput–C2) injuries compared with older children. The National Emergency X-Radiography Utilization Study protocol may have lower sensitivity in young children than in adults. Limited computed tomography from occiput–C3 may increase diagnostic yield appreciably in young children compared with flexion-extension views. Further prospective studies, especially of young children, are needed to develop reliable pediatric protocols.

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CT Better Than X-Rays for Diagnosis Of High-Risk Cervical Spine Injury

Family Practice News ◽

10.1016/s0300-7073(07)70381-x ◽

2007 ◽

Vol 37 (6) ◽

pp. 31

Author(s):

MICHELE G. SULLIVAN

Keyword(s):

Cervical Spine ◽

High Risk ◽

Cervical Spine Injury ◽

Spine Injury ◽

X Rays ◽

Better Than

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Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd012989 ◽

2018 ◽

Author(s):

Bruno T Saragiotto ◽

Christopher G Maher ◽

Chung-Wei Christine Lin ◽

Arianne P Verhagen ◽

Stacy Goergen ◽

...

Keyword(s):

Cervical Spine ◽

Blunt Trauma ◽

Cervical Spine Injury ◽

Spine Injury ◽

National Emergency

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Comparison of the efficacy of three cervical collars in restricting cervical range of motion: A randomized study

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918809499 ◽

2018 ◽

Vol 27 (1) ◽

pp. 24-29 ◽

Cited By ~ 2

Author(s):

Jae Guk Kim ◽

Sung Hwan Bang ◽

Gu Hyun Kang ◽

Yong Soo Jang ◽

Wonhee Kim ◽

...

Keyword(s):

Cervical Spine ◽

Range Of Motion ◽

Cervical Spine Injury ◽

Axial Rotation ◽

The Other ◽

Spine Injury ◽

Cervical Range Of Motion ◽

Flexion Extension ◽

Cervical Immobilization ◽

The Difference

Background: The cervical collar has been used as a common device for the initial stabilization of the cervical spine. Although many cervical collars are commercially available, there is no consensus on which offers the greatest protection, with studies showing considerable variations in their ability to restrict cervical range of motion. The use of the XCollar (Emegear, Carpinteria, CA) has been known to decrease the risk of spinal cord injury by minimizing potential cervical spinal distraction. We compared XCollar with two other cervical collars commonly used for adult patients with cervical spine injury to evaluate the difference in effectiveness between the three cervical collars to restrict cervical range of motion. Objectives: This study aimed to evaluate the difference between the three cervical collars in their ability to restrict cervical range of motion. Method: A total of 30 healthy university students aged 21–25 years participated in this study. Participants with any cervical disease and symptoms were excluded. Three cervical collars were tested: Philadelphia® Collar, Stifneck® Select™ Collar, and XCollar. A digital camera and an image-analysis technique were used to evaluate cervical range of motion during flexion, extension, bilateral bending and bilateral axial rotation. Cervical range of motion was evaluated in both the unbraced and braced condition. Results: XCollar permitted less than a mean of 10° of movement during flexion, extension, bilateral bending and bilateral axial rotation. This was less than the movement permitted by the other two cervical collars. Conclusion: XCollar presented superior cervical immobilization compared to the other two commonly used cervical collars in this study. Thus, when cervical collar is considered for an adult patient with cervical spine injury, XCollar might be one of the considerate options as a cervical immobilization device.

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Five criteria can identify pediatric blunt trauma victims who are unlikely to need x-rays to exclude cervical spine injury

PsycEXTRA Dataset ◽

10.1037/e556662006-009 ◽

2001 ◽

Keyword(s):

Cervical Spine ◽

Blunt Trauma ◽

Cervical Spine Injury ◽

Spine Injury ◽

X Rays ◽

Trauma Victims

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Risk of Cervical Spine Injury and Other Complications Seen with Skull Fractures in the Setting of Mild Closed Head Injury in Young Children: A Retrospective Study

Pediatric Neurosurgery ◽

10.1159/000113114 ◽

2008 ◽

Vol 44 (2) ◽

pp. 124-127 ◽

Cited By ~ 1

Author(s):

Peter D. Kim ◽

Jennifer S. Jennings ◽

Mariah Fisher ◽

Adnan H. Siddiqui

Keyword(s):

Cervical Spine ◽

Retrospective Study ◽

Head Injury ◽

Young Children ◽

Cervical Spine Injury ◽

Closed Head Injury ◽

Spine Injury ◽

Skull Fractures ◽

Closed Head

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Utility of flexion-extension radiography for the detection of ligamentous cervical spine injury and its current role in the clearance of the cervical spine

Emergency Medicine Australasia ◽

10.1111/1742-6723.12525 ◽

2015 ◽

Vol 28 (2) ◽

pp. 216-223 ◽

Cited By ~ 6

Author(s):

Jason Jaeseong Oh ◽

Stephen Edward Asha

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Spine Injury ◽

Current Role ◽

Flexion Extension

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Evaluating the instability of injuries according to the AOSpine Subaxial Cervical Spine Injury Classification System

TRAUMA ◽

10.22141/1608-1706.2.22.2021.231957 ◽

2021 ◽

Vol 22 (2) ◽

pp. 34-44

Author(s):

O.S. Nekhlopochyn ◽

V.V. Verbov

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Classification System ◽

Cervical Spine Injury ◽

Sagittal Profile ◽

Spine Injury ◽

Subaxial Cervical Spine ◽

Flexion Extension ◽

Injury Classification ◽

Degree Of Instability

Background. The main criteria for determining surgery strategy in patients with traumatic subaxial cervical injury are as follows: the type and degree of damage to the osteo-ligamentous structures of cervical spine that determines the level of instability; the value of spinal cord compression; the state of the sagittal profile. The aim of this study was to assess the degree of instability in different types of cervical spine injuries according to AOSpine Subaxial Cervical Spine Injury Classification System. Materials and methods. We performed a retrospective analysis of Х-ray, computed tomography and magnetic resonance imaging data of 168 patients with traumatic injury of subaxial cervical spine. All of them were hospitalized at the Department of Spinal Cord Pathology of the Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine 2008–2018. We assessed the degree of instability using the Cervical Spine Injury Severity Score and determined the type of damage according to the AOSpine Subaxial Cervical Spine Injury Classification System. Results. We found that the median rate of instability increases progressively with increasing severity of injury type. The widest range of instability values is observed in the compression damage: from 6 points (95% confidence interval (CI): 4.76–6.84) in A1 type to 11 points (95% CI: 9.48–11.81) in A4. For A2 and A3 types, we registered 7 (95% CI: 6.68–7.53) and 8 points (95% CI: 7.97–9.01), respectively. A smaller range of values characterizes flexion-extension injuries. The median progressively increases from B1 type — 13 points (95% CI: 12.4–13.92) to B3 type — 15.5 points (95% CI: 14.5–16.35). The value for B2 is intermediate and is 15 points (95% CI: 13.59–15.52). We registered maximum values in flexion-extension injuries — 18 points, for both B2 and B3 types. C type has the highest level of instability — 17 points (95% CI: 16.58–17.86) and a quite wide range of estimated values: from 13 to 20 points. Conclusions. The general trend is an increase in the level of instability in the range from A1 to C injury subtypes, but even A1 type in some cases are quite unstable and require surgery. In contrast to the classical views, type A injuries are often accompanied by da-mage to the facet joints, which must also be taken into account when determining the individual treatment.

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