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Young vs old cervical spine x ray4/6/2024 This was a Health Insurance Portability and Accountability Act–compliant descriptive retrospective study performed after approval from the institutional review board at a pediatric tertiary referral center. The purpose of our study was to identify the incidence and types of CSI on MR imaging in a cohort of pediatric patients diagnosed with NAT with or without AHT and to correlate CSI with parenchymal injury on brain MR imaging and findings on head CT. The lack of clinical suspicion of CSI, along with coexistent head injuries, increases the risk of masking the clinical detection of CSI. This is frequently secondary to the absence of abnormalities on radiographs that are part of the routine NAT evaluation. 1, 2 The incidence of CSI is likely underestimated because cervical MR imaging is not generally part of the routine evaluation of nonaccidental trauma (NAT) with or without evidence of AHT. The infant or young child's physical features increase the risk of ligamentous CSI because of the presence of a relatively large head size, ligamentous laxity, and poorly developed paraspinal musculature. 6 ⇓ ⇓– 9 The ligamentous injury is believed to be secondary to a hyperflexion/hyperextension mechanism of injury, and the younger the child, the more likely the upper cervical spine is at risk for injury. 4, 5 Spinal injuries in AHT described in various studies include compression fractures, ligamentous injury, cord injury, and subdural hematoma. Recent literature suggests ligamentous injury documented on cervical MR imaging is commonly found in children with abusive head trauma (AHT). Ligamentous injury to the cervical spine is a well-recognized but likely underdocumented condition in pediatric cervical spine trauma, especially when accompanied by complex coexistent injuries or a delay in clinical symptoms. 2 A high clinical suspicion and the appropriate use of imaging are the key factors in identifying CSI. Younger children are also more likely to have a ligamentous injury than fractures. 1 There is a higher prevalence of upper cervical injury in infants and toddlers, secondary to mechanism of injury and physiologic immaturity. ![]() ABBREVIATIONS: AHT abusive head trauma CSI cervical spine injury NAT nonaccidental traumaĬervical spine injury (CSI) is uncommon in children, accounting for only 1–2% of pediatric trauma.
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