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Radiology of the Pediatric Cervical Spine

- See:
        - development of atlas
        - development of axis

- Discussion:
    - most pediatric C-spine injuries will occur above C3, and therefore lateral radiographs should be centered on C-3;
    - Atlantoaxial Rotatory Fixation:
    - SCIWORA: Syndrome of Spinal Cord Injury w/o Radiographic Abnormality;
           - accounts for up to 2/3 of severe cervical injuries in children < 8 years of age;
           - inherent elasticity in pediatric cervical spine can allow severe spinal cord injury to occur in absence of x-ray findings;
           - fracture through the cartilaginous end plates (which are not visualized by x-rays), may be among the causes of this injury;
           - radiographs:
                   - diagnosis of exclusion:
                   - MRI may give a more anatomic diagnosis by showing hemorrhage or edema of the spinal cord;
                   - pseudosubluxation: anterior displacement may be up to 4 mm;
           - treatment: spine is immobilized for one to three weeks;

- Radiographs:
    - lateral radiograph in children < 10 yrs of age:
           - atlantooccipital disassociation
           - atlas dens interval < 3.5 mm
           - cervical stenosis:
           - retropharyngeal space: (will increase w/ crying)
                 - C3: < 6-8 mm;
                 - C6: < 14 mm;
           - odontoid frxs: accounts for majority of pediatric C-spine frx (upto 75%)
           - development & anomalies of axis: (os odontoideum):
           - pseudosubluxation C2-3: 0-3 mm
                 - note that pediatric trauma patients should be placed on a trauma board which allows the head to slightly hyperextend;
                 - when placed on a standard truama board, the child's neck will flex (due to the large pediatric head size), which accentuates pseudosubluxation;
           - canal width: 14 mm;
                 - spinous process widening:
                 - C1-C2 interspinous space should not be greater than 10 mm;
                 - widening is present when the distance is more than 1.5 times the inter-spinous distance of adjacent spinal segments;
    - odontoid view:
           - combined lateral overhang of more than 7 mm of (C1-C2 facets) indicates an unstable Jefferson's Fracture;
    - oblique view:
           - oblique radiographs are not essential in the pediatric population, since facet injuries are uncommon

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