Examination of the Pediatric Cervical Spine Under Anesthesia.

Cervical spine injuries in pediatric patients can have devastating consequences if not properly diagnosed. The standard workup for suspected cervical spine injuries includes cervical X-rays and a high-resolution CT. If suspicion still exists then a cervical MRI is obtained. When the cervical MRI shows ligamentous edema but is unable to determine the integrity of the ligaments then additional workup is needed. Often a flexion and extension lateral cervical X-ray can help determine ligament integrity in the non-sedated cooperative age-appropriate patient. For pediatric patients who are unable to perform the flexion and extension X-ray, we perform a dynamic fluoroscopic examination of the cervical spine under anesthesia. The patient is positioned in the supine position. The C-arm is positioned in the lateral position. The surgeon manually performs distraction, flexion, extension, and translation maneuvers while obtaining live fluoroscopy and assessing for signs of cervical instability. If cervical instability exists then the appropriate definitive treatment can be performed. If the cervical spine is stable then cervical immobilization can be discontinued.