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Interesting Case Discussion and Imaging Approach in Pediatric Cervical Spine Trauma

Interesting Case Discussion and Imaging Approach in Pediatric Cervical Spine Trauma. Pediatric Versus Adult Cervical Spine. Pediatric Cervical Spine Injuries (CSIs) present differently when compared to adults.. Why?. Fulcrum of motion in the pediatric cervical spine –

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Interesting Case Discussion and Imaging Approach in Pediatric Cervical Spine Trauma

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  1. Interesting Case Discussion and Imaging Approach in Pediatric Cervical Spine Trauma

  2. Pediatric Versus Adult Cervical Spine Pediatric Cervical Spine Injuries (CSIs) present differently when compared to adults.. Why? • Fulcrum of motion in the pediatric cervical spine – • Is at higher level (C2-C3 level) • as against C5-C6in adults (1,2) • Hypermobile Spine in children(2-8) – Bony, Ligamentous and Muscular factors • Difference in proportion head vs rest of the body (9)

  3. Case 1: Is this a subluxation? Diagnosis: Pseudosubluxation

  4. Psudosubluxation Vs True Subluxation • Swischuk Line/ Spinolaminar/posterior cervical line: Line from the anterior aspect of C1-C3 spinous process. Anterior C2 spinous process should be within 2mm (10)

  5. Case 2: Whats This?

  6. Lt Para sag CT Rt Para sag CT Diagnosis: Bilateral Pars defect with mild subluxation of C6 over C7 vertebra

  7. Do you think wedging is normal in 3 year old? In early infancy cervical vertebrae have an oval appearance Anterior wedging of 3 mm, should not be confused with compression fracture. Such wedging can be profound at C3 level

  8. Case 3: Wedging in 8 year old? Diagnosis : Burst fracture of C3

  9. Imaging Approach to Pediatric Cervical Spine Trauma • Pediatric CSI are rare, therefore management principles are still mostly controversial(11) • According to a recent review article, diagnostic principles has been tabulated as follows (11)

  10. Summary: What you need to know?Normal Measurements of Upper Cervical Spine on Conventional Radiograph

  11. Summary: What you need to knowNormal Measurements of Upper Cervical Spine on CT

  12. 1) Kokoska ER, Keller MS, Rallo MC, Weber TR. Characteristics of pediatric cervical spine injuries. J Pediatr Surg 2001; 36:100–105 • 2) Roche C, Carty H. Spinal trauma in children. PediatrRadiol 2001; 31:677–700 • 3) McGrory BJ, Klassen RA, Chao EY, Staeheli JW, Weaver AL. Acute fractures and dislocations of the cervical spine in children and adolescents. J Bone Joint Surg Am 1993; 75:988–995 • 4) Herman MJ, Pizzutillo PD. Cervical spine disorders in children. Orthop Clin North Am 1999; 30:457–466, ix • 5) Harris JH Jr, Mirvis SE. The radiology of acute cervical spine trauma. In: Mitchell CW, ed. The normal cervical spine. 3rd ed. Baltimore, Md: Williams & Wilkins, 1996; 1–73

  13. 6)Swischuk LE. Emergency imaging of the acutely ill or injured child. In: The spine and the spinal cord. 4th ed. Philadelphia, Pa: Lippincott Williams &Wilkins, 2000; 532–587 • 7) Marx Rosen’s emergency medicine: concepts and clinical practice. 5th ed. St Louis, Mo: Mosby, 2002; 274–276 • 8) Reynolds R. Pediatric spinal injury. CurrOpinPediatr 2000; 12:67–71 • 9)Huelke DF. An Overview of Anatomical Considerations of Infants and Children in the Adult World of Automobile Safety Design. Annual Proceedings / Association for the Advancement of Automotive Medicine. 1998;42:93-113. • 10) Swischuk LE. Emergency imaging of the acutely ill or injured child. In: The spine and the spinal cord. 4th ed. Philadelphia, Pa: Lippincott Williams &Wilkins, 2000; 532–587 • 11)Gopinathan NR, Viswanathan VK, Crawford AH. Cervical spine evaluation in pediatric trauma: A review and an update of current concepts. Indian J Orthop 2018;52:489-500 • 12) Timothy N Booth American Journal of Roentgenology. 2012;198: W417-W425. 10.2214/AJR.11.8150

  14. Authors Name: Subramanian Surabhi Pierre Schmit Kathleen O’Brien Naeem Khan Affiliation: Department of Diagnostic Radiology, IWK Health Centre

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