Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR, 72202, United States.
College of Medicine, University of Arkansas for Medical Sciences, 5301 W Markham St, Slot 520, Little Rock, AR, 72205, United States.
Am J Surg. 2023 Jul;226(1):122-127. doi: 10.1016/j.amjsurg.2023.03.001. Epub 2023 Mar 3.
Traumatic cervical spine injury (CSI) is fundamentally different in children, and imaging recommendations vary; however, prompt diagnosis is necessary.
We conducted a retrospective cohort study, evaluating children who presented after traumatic injury from 7/1/2012 to 12/31/2019 receiving a cervical spine CT. Evaluation of the incidence and clinical significance of CSI undetected on CT subsequently diagnosed on MRI was conducted. Additionally, all with CSI underwent image review to evaluate for potential overlooked, but visible pathology.
1487 children underwent a cervical spine CT, revealing 52 with CSI. 237 underwent MRI due to an abnormal CT or continued clinical concern. Ultimately, three were discovered to have clinically significant CSI missed on CT. In all cases, retrospective review demonstrated a retroclival hematoma when soft tissue windows were formatted in sagittal and coronal views.
A normal CT may be sufficient to rule-out clinically significant CSI. However, the presence of a retroclival hematoma must be evaluated.
儿童外伤性颈椎损伤（CSI）在本质上与成人不同，影像学推荐也有所不同；然而，及时诊断是必要的。
我们进行了一项回顾性队列研究，评估了 2012 年 7 月 1 日至 2019 年 12 月 31 日期间因外伤性损伤就诊的儿童，他们接受了颈椎 CT 检查。评估了随后在 MRI 上诊断但在 CT 上未发现的 CSI 的发生率和临床意义。此外，所有 CSI 患者均进行了图像复查，以评估是否存在潜在的但易被忽视的病理变化。
1487 名儿童接受了颈椎 CT 检查，发现 52 名儿童有 CSI。237 名因 CT 异常或持续的临床关注而接受 MRI 检查。最终，有 3 名儿童被发现有 CT 漏诊的临床显著 CSI。在所有情况下，当矢状位和冠状位采用软组织窗进行复查时，都发现了斜坡后血肿。
正常 CT 可能足以排除临床显著 CSI。然而，必须评估斜坡后血肿的存在。
