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Erschienen in: European Journal of Trauma and Emergency Surgery 6/2013

01.12.2013 | Review Article

Special considerations in the interpretation of plain radiographs of the cervical spine in children. A review of the literature

verfasst von: C. Schöneberg, B. Schweiger, S. Lendemans, C. Waydhas

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 6/2013

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Abstract

Introduction

This review provides an overview of the special considerations with regard to correct diagnosis of plain radiographs of the pediatric cervical spine. Injuries to the cervical spine are rare in children. The leading trauma mechanism is motor vehicle injury. Plain radiographs are a common tool in the search for a diagnosis. Taking the growth process into account there are many differences to be found compared to the adult c-spine. Knowledge of these differences is important when working towards the correct interpretation of plain radiographs of the pediatric c-spine.

Methods

To create this review, a literature search of the electronic databases Cochrane, PubMed/MEDLINE and Embase was conducted.

Results

Special considerations of plain radiographs of the pediatric c-spine are presented. Biomechanical and embryology specifics have been a focus of this review. They are explained relating on the development of the c-spine. The known auxiliary lines used in the interpreting of the pediatric c-spine are reported. A selection of these auxiliary lines is shown.

Conclusion

Knowledge of the c-spines characteristics is of major importance for every physician involved in pediatric trauma care. This could lead to not only avoiding misdiagnosis but could also lead to avoiding the overuse of computed tomography of the pediatric c-spine.
Literatur
1.
Zurück zum Zitat Schöneberg C, Schweiger B, Hussmann B et al. (2013) Diagnosis of cervical spine injuries in children. A systematic review. Eur J Trauma Emerg Surg. doi:10.1007/s00068-013-0295-1. Schöneberg C, Schweiger B, Hussmann B et al. (2013) Diagnosis of cervical spine injuries in children. A systematic review. Eur J Trauma Emerg Surg. doi:10.​1007/​s00068-013-0295-1.
2.
Zurück zum Zitat Kokoska ER, Keller MS, Rallo MC, et al. Characteristics of pediatric cervical spine injuries. J Pediatr Surg. 2001;36:100–5.PubMedCrossRef Kokoska ER, Keller MS, Rallo MC, et al. Characteristics of pediatric cervical spine injuries. J Pediatr Surg. 2001;36:100–5.PubMedCrossRef
3.
Zurück zum Zitat Patel JC, Tepas JJ, Mollitt DL, et al. Pediatric cervical spine injuries: defining the disease. J Pediatr Surg. 2001;36:373–6.PubMedCrossRef Patel JC, Tepas JJ, Mollitt DL, et al. Pediatric cervical spine injuries: defining the disease. J Pediatr Surg. 2001;36:373–6.PubMedCrossRef
4.
Zurück zum Zitat Brown RL, Brunn MA, Garcia VF. Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg. 2001;36:1107–14.PubMedCrossRef Brown RL, Brunn MA, Garcia VF. Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg. 2001;36:1107–14.PubMedCrossRef
5.
Zurück zum Zitat Wang JC, Nuccion SL, Feighan JE, et al. Growth and development of the pediatric craniocervical junction an the subaxial spine. In Brockmeyer, L D. Advanced pediatric craniocervical surgery. New York: Thieme; 2006. p. 27–42. Wang JC, Nuccion SL, Feighan JE, et al. Growth and development of the pediatric craniocervical junction an the subaxial spine. In Brockmeyer, L D. Advanced pediatric craniocervical surgery. New York: Thieme; 2006. p. 27–42.
6.
Zurück zum Zitat Fesmire FM, Luten RC. The pediatric cervical spine: developmental anatomy and clinical aspects. J Emerg Med. 1989;7:133–42.PubMedCrossRef Fesmire FM, Luten RC. The pediatric cervical spine: developmental anatomy and clinical aspects. J Emerg Med. 1989;7:133–42.PubMedCrossRef
7.
Zurück zum Zitat Ogden JA. Radiology of postnatal skeletal development. XII. The second cervical vertebra. Skeletal Radiol. 1984;12:169–77.PubMedCrossRef Ogden JA. Radiology of postnatal skeletal development. XII. The second cervical vertebra. Skeletal Radiol. 1984;12:169–77.PubMedCrossRef
8.
Zurück zum Zitat Liang CL, Lui CC, Lu K, et al. Atlantoaxial stability in ossiculum terminale. Case report. J neurosurg. 2001;95:119–21. Liang CL, Lui CC, Lu K, et al. Atlantoaxial stability in ossiculum terminale. Case report. J neurosurg. 2001;95:119–21.
9.
Zurück zum Zitat Loder RT. The cervical spine. In: Morrissy RT, editor. Lovell and Winter’s Pediatric Orthopedics. 4th ed. Philadelphia: Lippincott-Raven; 1996. p. 739–79. Loder RT. The cervical spine. In: Morrissy RT, editor. Lovell and Winter’s Pediatric Orthopedics. 4th ed. Philadelphia: Lippincott-Raven; 1996. p. 739–79.
10.
12.
Zurück zum Zitat Baker DH, Berdon WE. Special trauma problems in children. Radiology. 1952;59:712–9. Baker DH, Berdon WE. Special trauma problems in children. Radiology. 1952;59:712–9.
13.
Zurück zum Zitat Townsend EH, Rowe ML. Mobility of the upper cervical spine in health and disease. Pediatrics. 1952;10:567–74.PubMed Townsend EH, Rowe ML. Mobility of the upper cervical spine in health and disease. Pediatrics. 1952;10:567–74.PubMed
14.
Zurück zum Zitat Grabb PA, Hadley MN. Spinal column trauma in children. In: Albright AL, Pollack IF, Adelson PD, editors. Principles and practice of pediatric neurosurgery. New York: Thieme; 1999. p. 935–53. Grabb PA, Hadley MN. Spinal column trauma in children. In: Albright AL, Pollack IF, Adelson PD, editors. Principles and practice of pediatric neurosurgery. New York: Thieme; 1999. p. 935–53.
15.
Zurück zum Zitat Locke GR, Gardner JI, Van Epps EF. Atlas-dens interval (ADI) in children: a survey based on 200 normal cervical spines. Am J Roentgenol Radium Ther Nucl Med. 1966;97:135–40.PubMedCrossRef Locke GR, Gardner JI, Van Epps EF. Atlas-dens interval (ADI) in children: a survey based on 200 normal cervical spines. Am J Roentgenol Radium Ther Nucl Med. 1966;97:135–40.PubMedCrossRef
16.
Zurück zum Zitat Wang JC, Nuccion SL, Feighan JE, et al. Growth and development of the pediatric cervical spine documented radiographically. J Bone Surg Am. 2001;83:1212–8.PubMed Wang JC, Nuccion SL, Feighan JE, et al. Growth and development of the pediatric cervical spine documented radiographically. J Bone Surg Am. 2001;83:1212–8.PubMed
17.
Zurück zum Zitat White AA, Panjabi MM. Clinical biomechanics of the spine. Philadelphia: Lippincott; 1990. White AA, Panjabi MM. Clinical biomechanics of the spine. Philadelphia: Lippincott; 1990.
18.
Zurück zum Zitat Cattell HS, Filtzer DL. Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Jt Surg Am. 1965;47:1295–309. Cattell HS, Filtzer DL. Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Jt Surg Am. 1965;47:1295–309.
19.
Zurück zum Zitat Lustrin ES, Karakas SP, Ortiz AO, et al. Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 2003;23:539–60.PubMedCrossRef Lustrin ES, Karakas SP, Ortiz AO, et al. Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 2003;23:539–60.PubMedCrossRef
20.
Zurück zum Zitat Suss RA, Zimmerman RD, Leeds NE. Pseudospread of the atlas: false sign of Jefferson fracture in young children. Am J Roentgenol. 1983;140:1079–82.CrossRef Suss RA, Zimmerman RD, Leeds NE. Pseudospread of the atlas: false sign of Jefferson fracture in young children. Am J Roentgenol. 1983;140:1079–82.CrossRef
21.
Zurück zum Zitat Shaw M, Burnett H, Wilson A, et al. Pseudosubluxation of C2 on C3 in polytraumatized children—prevalence and significance. Clin Radiol. 1999;54:377–80.PubMedCrossRef Shaw M, Burnett H, Wilson A, et al. Pseudosubluxation of C2 on C3 in polytraumatized children—prevalence and significance. Clin Radiol. 1999;54:377–80.PubMedCrossRef
22.
Zurück zum Zitat Mortazavi M, Gore PA, Chang S, et al. Pediatric cervical spine injuries: a comprehensive review. Chils Nerv Syst. 2011;27:705–17.CrossRef Mortazavi M, Gore PA, Chang S, et al. Pediatric cervical spine injuries: a comprehensive review. Chils Nerv Syst. 2011;27:705–17.CrossRef
23.
Zurück zum Zitat Pang D, Sun PP. Pediatric vertebral column and spinal cord injuries. In: Winn HR, editor. Neurological surgery. Philadelphia: WB Saunders; 2004. p. 3515–57. Pang D, Sun PP. Pediatric vertebral column and spinal cord injuries. In: Winn HR, editor. Neurological surgery. Philadelphia: WB Saunders; 2004. p. 3515–57.
24.
Zurück zum Zitat Ware ML, Gupta N, Sun PP, et al. Clinical biomechanics of the pediatric craniocervical junction and subaxial spine. In: Brockmeyer DL, editor. Advanced pediatric craniocervical surgery. New York: Thieme; 2006. p. 27–42. Ware ML, Gupta N, Sun PP, et al. Clinical biomechanics of the pediatric craniocervical junction and subaxial spine. In: Brockmeyer DL, editor. Advanced pediatric craniocervical surgery. New York: Thieme; 2006. p. 27–42.
25.
Zurück zum Zitat Blauth M, Schmidt U, Otte D, et al. Fractures of the odontoid process in small children: biomechanical analysis and report of three cases. Eur Spine J. 1996;5:63–70.PubMedCrossRef Blauth M, Schmidt U, Otte D, et al. Fractures of the odontoid process in small children: biomechanical analysis and report of three cases. Eur Spine J. 1996;5:63–70.PubMedCrossRef
26.
Zurück zum Zitat Connolly B, Emery D, Armstrong D. The odontoid synchondrotic slip: an injury unique to young children. Pediatr Radiol. 1995;25(Suppl 1):129–33. Connolly B, Emery D, Armstrong D. The odontoid synchondrotic slip: an injury unique to young children. Pediatr Radiol. 1995;25(Suppl 1):129–33.
27.
Zurück zum Zitat McCall T, Fassett D, Brockmeyer D. Cervical spine trauma in children: a review. Neurosurg Focus. 2006;20:1–8. McCall T, Fassett D, Brockmeyer D. Cervical spine trauma in children: a review. Neurosurg Focus. 2006;20:1–8.
28.
Zurück zum Zitat Judd DB, Liem LK, Ptermann G. Pediatric atlas fracture: a case of fracture through a synchondrosis and review of the literature. Neurosurgery. 2000;46:991–4.PubMed Judd DB, Liem LK, Ptermann G. Pediatric atlas fracture: a case of fracture through a synchondrosis and review of the literature. Neurosurgery. 2000;46:991–4.PubMed
29.
Zurück zum Zitat Swischuk LE, Swischuk PN, John SD. Wedging of C-3 in infants and children: usually a normal finding and not a fracture. Radiology. 1993;188:523–6.PubMed Swischuk LE, Swischuk PN, John SD. Wedging of C-3 in infants and children: usually a normal finding and not a fracture. Radiology. 1993;188:523–6.PubMed
30.
Zurück zum Zitat Wackenheim A. Roentgen diagnosis of craniovertebral region New York: Springer Verlag; 1974. Wackenheim A. Roentgen diagnosis of craniovertebral region New York: Springer Verlag; 1974.
31.
Zurück zum Zitat Swischuk LE. Anterior displacement of C2 in children: Physiologic or pathologic. Radiology. 1977;122:759–63.PubMed Swischuk LE. Anterior displacement of C2 in children: Physiologic or pathologic. Radiology. 1977;122:759–63.PubMed
32.
Zurück zum Zitat Sun PP, Poffenbarger GJ, Durham S, et al. Spectrum of occipitoatlantoaxial injury in young children. J Neurosurg. 2000;93(Suppl 1):28–39.PubMed Sun PP, Poffenbarger GJ, Durham S, et al. Spectrum of occipitoatlantoaxial injury in young children. J Neurosurg. 2000;93(Suppl 1):28–39.PubMed
33.
Zurück zum Zitat Powers B, Miller MD, Kramer RS, et al. Traumatic anterior atlanto-occipital dislocation. Neurosurgery. 1979;4:12–7.PubMedCrossRef Powers B, Miller MD, Kramer RS, et al. Traumatic anterior atlanto-occipital dislocation. Neurosurgery. 1979;4:12–7.PubMedCrossRef
34.
Zurück zum Zitat Kaufman RA, Carroll CD, Buncher CR. Atlantooccipital junction: standards for measurement in normal children. Am J Neuroradiol. 1987;8:995–9.PubMed Kaufman RA, Carroll CD, Buncher CR. Atlantooccipital junction: standards for measurement in normal children. Am J Neuroradiol. 1987;8:995–9.PubMed
35.
Zurück zum Zitat Harris JH, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR. 1994;162:881–6.PubMedCrossRef Harris JH, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR. 1994;162:881–6.PubMedCrossRef
Metadaten
Titel
Special considerations in the interpretation of plain radiographs of the cervical spine in children. A review of the literature
verfasst von
C. Schöneberg
B. Schweiger
S. Lendemans
C. Waydhas
Publikationsdatum
01.12.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 6/2013
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-013-0305-3

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