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Radiographics. 2019 Jul-Aug;39(4):1126-1142. doi: 10.1148/rg.2019180100. Epub 2019 Jun 7.

Emergent Imaging of Pediatric Cervical Spine Trauma.

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From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, and Department of Radiology, The Ohio State University, Columbus, Ohio (A.S.M.); Department of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, Ohio (U.N.); and Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health, Indianapolis, Ind (R.R.).


Owing to physiologic and biomechanical differences, the incidence, patterns, distributions, and mechanisms of spinal injury in children differ from those in adults. Furthermore, evaluation of the spine can be complicated by synchondroses, developmental and/or anatomic variants, and interpretative pitfalls that are unique to the developing spine of a child. Although the incidence of spinal injury is lower in children, the sequelae are more severe, with higher morbidity and mortality. Mechanistic differences, notably nonaccidental trauma in infants and toddlers; physiologic differences, notably a disproportionately large head relative to body size and ligamentous and soft-tissue laxity; and the propensity of these injuries to occur at higher spinal levels (craniocervical junction to C3) are contributing factors. In addition, imaging recommendations for children are different. Assessment of spinal alignment and adjacent soft tissues, particularly at the craniocervical junction, with a low threshold for performing MRI, is key to diagnosing these serious injuries. The patterns of common pediatric cervical spine injuries, including craniocervical junction injury and spinal cord injury without a correlating radiographic abnormality, are reviewed. ©RSNA, 2019.


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