Keywords:
Trauma, Paediatric, CT, MR, Conventional radiography, Diagnostic procedure
Authors:
J. B. Davies, R. Berkeley, D. Pefanis, W. Tilden, R. Wheeler, S. G. Cross; London/UK
Results
447 patients under 10 years of age underwent imaging of the c-spine for suspected CSI following blunt trauma during the study period.
7 (1.57% of total) cases of CSI were confirmed in this group,
mean age 3.6 years.
Of the 7 cases of CSI,
4 were female and 3 were male.
All cases of CSI occurred secondary to “high energy trauma”.
5 cases occurred following falls from height,
one following a high speed road traffic collision and one following suspected non-accidental injury.
Only one patient had a GCS greater than 8 on admission and only one case was not associated with other,
severe injuries.
CT detected injuries in only 6 of the 7 cases and MRI detected further significant soft tissue injuries in all cases.
5 of 7 cases demonstrated injury at C2 or above (mean age equals 4.3 years) and 4 of 7 cases had injuries below the C2 level (mean age = 3.1 years) (Table 1).
Table 1
Case
|
Age
|
Mechanism
|
Imaging findings and modality
|
1
|
2.7 Years
|
Fall from height (3 floors)
|
CT:
Occipital condyle fracture
C5/6 Compression fracture with spinous / transverse process avulsion fractures
C7: Burst fracture
MRI:
Epidural haematoma,
disruption of the PLL and interspinous ligmantous strain
|
2
|
4.1 Years
|
Fall from height (4 floors)
|
CT:
C7 spinous process fracture
MR:
C1-2,
C5-7 Interspinous ligament strain
Epidural haematoma
|
3
|
3.6 Years
|
Fall from height (1 floor)
|
X-ray Findings
No injury identified
CT Findings:
No injury identified
MR:
PLL strain
Interspinous ligaments injury
Spinal cord injury without radiological abnormality (SCIWORA) at C2
|
4
|
3.6 Years
|
Road Traffic Collision (> 30 mph)
|
CT:
Malalignment of C1 on C2 indicating ligamentous injury
|
5
|
8.4 Years
|
Fall from height (15 floors)
|
CT:
C1 burst fracture
Rotational malalignment of C1 on C2
|
6
|
1.8 Years
|
Non Accidental injury (fall down 20 steps)
|
CT:
Type 2 Dens fracture
|
7
|
2.1 Years
|
Fall from height (3 stories)
|
CT:
Left C7 pedicle / lamina fracture,
extending into the transverse process
MRI
Anterior and posterior cervical epidural haematoma
|