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The pediatric cervical spine instability study

A pilot study assessing the prognostic value of four imaging modalities in clearing the cervical spine for children with severe traumatic injuries

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Abstract

Purpose

Cervical spine clearance in severely injured children after trauma is often difficult because of unique injury patterns, concerns about radiation exposure to growing tissue, and unfamiliarity with unstable cervical injuries. We prospectively assessed the utility of four radiographic modalities to clear the cervical spine in children after severe trauma.

Methods

Twenty-four comatose, intubated children with severe traumatic injuries underwent radiographic evaluation to clear the cervical spine. Each patient had plain radiographs, flexion–extension radiographs under fluoroscopy, computed tomography (CT), and magnetic resonance (MR) imaging within 10 days of admission. Patients underwent cervical spine flexion–extension radiographs 2–3 months after trauma to detect late instability. Sensitivity and specificity for each radiographic modality was determined.

Results

Plain cervical spine radiographs demonstrated sensitivity of 100% and specificity of 95%; flexion–extension radiographs had “indeterminate” sensitivity and specificity of 100%. For CT, sensitivity was 100% and specificity was 95%, and for MR imaging, sensitivity was 100% and specificity was 74%.

Conclusions

There was a low prevalence of cervical instability in this high-risk group. Plain radiographs, flexion–extension radiographs, and CT all had high sensitivities and specificities. MR imaging had a high false-positive rate, making it sensitive but not specific. The data support using either CT or plain radiographs as the initial cervical spine screening study, but CT is recommended because of its superior ability to detect critical injuries. To definitively rule out ligamentous instability after a negative screening CT scan or cervical spine X-ray, these data support using flexion–extension X-rays with fluoroscopy and not MR imaging.

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Acknowledgements

The authors wish to acknowledge the assistance of Kristin Kraus, MSc, in the preparation of this manuscript. They also wish to thank the members of the DSMB for their time, insight, and expertise in the fields of cervical and pediatric trauma: Ronald Apfelbaum, MD, J. Michael Dean, MD, MBA, and Armand Antommaria, MD, PhD.

Disclosures

The authors do not report any conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The technical fees for the MR imaging portion of the study were funded by a grant from Primary Children’s Foundation.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Utah, 175 N. Medical Drive, Salt Lake City, UT, 84132, USA

    Douglas L. Brockmeyer & John R. W. Kestle

  2. Department of Neurosurgery, Oregon Health and Science University, Portland, OR, USA

    Brian T. Ragel

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  1. Douglas L. Brockmeyer
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  2. Brian T. Ragel
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  3. John R. W. Kestle
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Correspondence to Douglas L. Brockmeyer.

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Brockmeyer, D.L., Ragel, B.T. & Kestle, J.R.W. The pediatric cervical spine instability study. Childs Nerv Syst 28, 699–705 (2012). https://doi.org/10.1007/s00381-012-1696-x

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  • DOI: https://doi.org/10.1007/s00381-012-1696-x

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