Hale Andrew T, Alvarado Abraham, Bey Amita K, Pruthi Sumit, Mencio Gregory A, Bonfield Christopher M, Martus Jeffrey E, Naftel Robert P
Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN, USA.
Department of Radiology, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN, USA.
Childs Nerv Syst. 2017 Nov;33(11):1977-1983. doi: 10.1007/s00381-017-3448-4. Epub 2017 Jun 27.
Evaluation of cervical spine injury (CSI) in children requires rapid, yet accurate assessment of damage. Given concerns of radiation exposure, expert consensus advises that computed tomography (CT) should be used sparingly. However, CT can provide superior image resolution and detection of pathology. Herein, we evaluate if X-ray offers equal diagnostic accuracy compared to CT imaging in identifying CSI in children.
We conducted a retrospective study between October 2000 and March 2012 of pediatric patients evaluated for cervical spine injury at a level 1 trauma center. All patients included in this study were imaged with cervical spine X-rays and CT at the time of injury. Demographic information, mechanism of injury, significant versus non-significant injury (as defined by the NEXUS criteria), radiographic findings, level of the injury, presence of spinal cord injury, treatment, clinical outcome, and length of follow-up were collected. Chi-squared (χ ) and Fisher's exact tests were used as appropriate and means and standard deviations were reported.
We identified 1296 patients who were screened for CSI. Of those, 164 patients were diagnosed with spinal cord/column injuries (CSI). Eighty-nine patients were excluded for only having a CT or X-ray imaging without the other modality. Thus, a total of 75 patients with CSI were included in the final cohort. Using the NEXUS definitions, 78% of patients had clinically significant injuries while 22% had non-significant injuries. There were no injuries detected on X-ray that were not also detected on CT. For all injuries, X-ray sensitivity was 50.7%. X-rays were more sensitive to significant injuries (62.3%) compared in non-significant injuries, which were missed on all X-rays (0%). Therefore, X-rays did not identify 24 significant cervical spine injuries (32%) as defined by NEXUS.
CT is superior to X-rays in detecting both clinically significant and insignificant cervical spine injuries. These results were not dependent on patient age or location of the injury. We recommend CT imaging in the evaluation of suspected cervical spine injuries in children.
III.
评估儿童颈椎损伤（CSI）需要快速且准确地评估损伤情况。鉴于对辐射暴露的担忧，专家共识建议应谨慎使用计算机断层扫描（CT）。然而，CT能提供更高的图像分辨率并检测出病变。在此，我们评估在识别儿童CSI方面，X线与CT成像相比是否具有同等的诊断准确性。
我们对2000年10月至2012年3月期间在一级创伤中心接受颈椎损伤评估的儿科患者进行了一项回顾性研究。本研究纳入的所有患者在受伤时均接受了颈椎X线和CT检查。收集了人口统计学信息、损伤机制、严重与非严重损伤（如NEXUS标准所定义）、影像学表现、损伤水平、脊髓损伤的存在情况、治疗、临床结果及随访时间。根据情况使用卡方（χ²）检验和Fisher精确检验，并报告均值和标准差。
我们确定了1296例接受CSI筛查的患者。其中，164例患者被诊断为脊髓/脊柱损伤（CSI）。89例患者因仅进行了CT或X线成像而未进行另一种检查而被排除。因此，最终队列共纳入75例CSI患者。根据NEXUS定义，78%的患者有临床显著损伤，22%有非显著损伤。X线未检测出CT未检测到的损伤。对于所有损伤，X线敏感性为50.7%。与非显著损伤相比，X线对显著损伤更敏感（62.3%），所有非显著损伤在X线上均未被检测到（0%）。因此，X线未识别出NEXUS定义的24例显著颈椎损伤（32%）。
在检测临床显著和非显著颈椎损伤方面，CT优于X线。这些结果不依赖于患者年龄或损伤部位。我们建议对疑似儿童颈椎损伤进行CT成像评估。
III级
