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The utility of magnetic resonance imaging in pediatric trauma patients suspected of having cervical spine injuries

Derderian, S. Christopher MD; Greenan, Krista MD; Mirsky, David M. MD; Stence, Nicholas V. MD; Graber, Sarah CCRP; Hankinson, Todd C. MD; Hubbell, Noah BA; Alexander, Allyson MD, PhD; O'Neill, Brent R. MD; Wilkinson, C. Corbett MD; Handler, Michael H. MD

Journal of Trauma and Acute Care Surgery: December 2019 - Volume 87 - Issue 6 - p 1328–1335
doi: 10.1097/TA.0000000000002487

BACKGROUND Pediatric cervical spine injuries (CSI) are rare but potentially devastating sequelae of blunt trauma. Existing protocols to evaluate children at risk for CSI frequently incorporate computed topography (CT) and magnetic resonance imaging (MRI); however, the clinical value of performing both remains unclear.

METHODS Single-center retrospective review of pediatric trauma patients who underwent both CT and MRI of the cervical spine between 2001 and 2015. Based on radiographic findings, CT and MRI results were grouped into one of three categories: no injury, stable injury, or unstable injury. Radiographic instability was defined by disruption of two or more contiguous spinal columns while radiographic stability was defined by any other acute cervical spine abnormality on imaging. Clinical instability was defined by the need for surgical intervention (halo or spinal fusion), with the remaining patients, including children discharged in a cervical collar, considered clinically stable.

RESULTS In total, 221 children met inclusion criteria, with a median age of 9 (interquartile range, 3–14). The Glasgow Coma Scale (GCS) score of the cohort was 9 (interquartile range, 4–15). Thirty-three (14.9%) children had clinically unstable injuries, requiring surgical intervention. Among the 160 (72.4%) children with no injury on CT, MRI identified no injury in 84 (52.5%) cases, a stable injury in 76 (47.5%) cases, and an unstable injury in none. Among the 21 children with stable injuries on CT, MRI findings were concordant in 17 (81.0%) cases. In four (19.0%) cases, a spinal column injury was identified on CT and appeared to be stable, but later deemed unstable on MRI. Forty (18.1%) patients had an unstable injury on CT with 100% MRI concordance.

CONCLUSION In pediatric trauma patients suspected of having a CSI, a normal cervical spine CT is sufficient to rule out a clinically significant CSI as no child with a normal cervical CT was found to be radiographically or clinically unstable.

LEVEL OF EVIDENCE Diagnostic Test, level III.

From the Department of Pediatric Surgery (S.C.D.); Department of Pediatric Neurosurgery (K.G., S.G., T.C.H., N.H., A.A., B.R.O., C.C.W., M.H.H.); Department of Radiology (D.M.M., N.V.S.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.

Submitted: March 6, 2019, Revised: June 9, 2019, Accepted: July 8, 2019, Published online: August 16, 2019.

These data have been presented at the Western Pediatric Trauma Conference, Park City, Utah, July 18-22, 2018.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Michael H. Handler, MD, Children's Hospital Colorado, University of Colorado School of Medicine 13123 E 16th Ave, Box 330 Aurora, CO 8004; email:

Online date: August 17, 2019

© 2019 Lippincott Williams & Wilkins, Inc.