Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury
Background In pediatric trauma patients, 60–80% of spinal cord injuries involve the cervical vertebrae. While the American College of Radiology offers guidelines for best imaging practices in the setting of acute pediatric trauma, there is a lack of uniformity in imaging-decision protocols across in...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-08-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/8/1/e001016.full |
| _version_ | 1827139784887238656 |
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| author | Jeff F Zhang Richard D Thomas Janet Umenta Adil Ali Renee Reynolds Phillip Benson Ham Ravi Piryani Muhammad Izhar Brian Wrotniak Anil K Swayampakula |
| author_facet | Jeff F Zhang Richard D Thomas Janet Umenta Adil Ali Renee Reynolds Phillip Benson Ham Ravi Piryani Muhammad Izhar Brian Wrotniak Anil K Swayampakula |
| author_sort | Jeff F Zhang |
| collection | DOAJ |
| description | Background In pediatric trauma patients, 60–80% of spinal cord injuries involve the cervical vertebrae. While the American College of Radiology offers guidelines for best imaging practices in the setting of acute pediatric trauma, there is a lack of uniformity in imaging-decision protocols across institutions. MRI has been shown to demonstrate high sensitivity for both bony and ligamentous injuries while also avoiding unnecessary radiation exposure in the pediatric patient population. However, the efficacy of flexion-extension (FE) radiography following initial MRI has not been evaluated in children. Our hypothesis is that FE radiography conducted following an initial MRI does not contribute significant diagnostic information or reduce time to cervical collar removal and thus can be removed from institutional protocols in order to avoid unnecessary testing and reduce pediatric radiation exposure.Methods Trauma data were collected for pediatric patients presenting with suspected acute cervical spine injury from 2014 to 2021. A total of 108 patients were subdivided into 41 patients who received “MRI Only” and 67 patients who received both “MRI and FE” diagnostic cervical spine imaging. Chi-square testing and t-tests were performed to determine differences between MRI and FE radiographic detection rates of bony and ligamentous injuries in the subgroups.Results In patients for whom FE did not find any injury, MRI detected bony and ligamentous injuries in 9/63 and 12/65 cases, respectively. In 3/21 (14.3%) cases in which MRI detected a bony and/or ligamentous injury and FE did not, patients eventually required surgical intervention for c-spine stabilization. No patients required surgical fixation when FE radiography showed an abnormality and MRI was normal. Addition of follow-up FE radiography after initial MRI did not have a significant effect on overall hospital length of stay (MRI Only vs MRI+FE: 9.2±12.0 days vs 8.6±13.5 days, p=0.816) or on rates of collar removal at discharge or greater than 48 hours after imaging (MRI Only vs MRI+FE: 41.5% vs 56.7%, p=0.124).Conclusions FE radiography following initial MRI did not have a significant effect on reducing time to cervical collar removal or overall hospital length of stay. In addition, in 3 of 6 cases (50.0%) in which surgical fixation was required, MRI detected ligamentous and/or bony injury while FE radiography was normal.Level of Evidence This study contributes Level 2b scientific evidence consistent with a well-designed cohort or case-control analytic study. |
| first_indexed | 2024-03-08T17:15:44Z |
| format | Article |
| id | doaj.art-65a329db51af4c24b61ec45f9c677e47 |
| institution | Directory Open Access Journal |
| issn | 2397-5776 |
| language | English |
| last_indexed | 2025-03-20T18:44:45Z |
| publishDate | 2023-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj.art-65a329db51af4c24b61ec45f9c677e472024-08-24T17:30:10ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762023-08-018110.1136/tsaco-2022-001016Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injuryJeff F Zhang0Richard D Thomas1Janet Umenta2Adil Ali3Renee Reynolds4Phillip Benson Ham5Ravi Piryani6Muhammad Izhar7Brian Wrotniak8Anil K Swayampakula9Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USADepartment of Radiology, John R Oishei Children`s Hospital, Buffalo, New York, USAJacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USAJacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USADepartment of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USADepartment of Surgery, Division of Pediatric Surgery, John R Oishei Children’s Hospital, Buffalo, New York, USADepartment of Pediatrics, Division of Critical Care Medicine, John R Oishei Children’s Hospital, Buffalo, New York, USADepartment of Radiology, John R Oishei Children`s Hospital, Buffalo, New York, USADepartment of Pediatrics, Division of Critical Care Medicine, John R Oishei Children’s Hospital, Buffalo, New York, USADepartment of Pediatrics, Pediatric Critical Care, Cook Children’s Medical Center, Fort Worth, Texas, USABackground In pediatric trauma patients, 60–80% of spinal cord injuries involve the cervical vertebrae. While the American College of Radiology offers guidelines for best imaging practices in the setting of acute pediatric trauma, there is a lack of uniformity in imaging-decision protocols across institutions. MRI has been shown to demonstrate high sensitivity for both bony and ligamentous injuries while also avoiding unnecessary radiation exposure in the pediatric patient population. However, the efficacy of flexion-extension (FE) radiography following initial MRI has not been evaluated in children. Our hypothesis is that FE radiography conducted following an initial MRI does not contribute significant diagnostic information or reduce time to cervical collar removal and thus can be removed from institutional protocols in order to avoid unnecessary testing and reduce pediatric radiation exposure.Methods Trauma data were collected for pediatric patients presenting with suspected acute cervical spine injury from 2014 to 2021. A total of 108 patients were subdivided into 41 patients who received “MRI Only” and 67 patients who received both “MRI and FE” diagnostic cervical spine imaging. Chi-square testing and t-tests were performed to determine differences between MRI and FE radiographic detection rates of bony and ligamentous injuries in the subgroups.Results In patients for whom FE did not find any injury, MRI detected bony and ligamentous injuries in 9/63 and 12/65 cases, respectively. In 3/21 (14.3%) cases in which MRI detected a bony and/or ligamentous injury and FE did not, patients eventually required surgical intervention for c-spine stabilization. No patients required surgical fixation when FE radiography showed an abnormality and MRI was normal. Addition of follow-up FE radiography after initial MRI did not have a significant effect on overall hospital length of stay (MRI Only vs MRI+FE: 9.2±12.0 days vs 8.6±13.5 days, p=0.816) or on rates of collar removal at discharge or greater than 48 hours after imaging (MRI Only vs MRI+FE: 41.5% vs 56.7%, p=0.124).Conclusions FE radiography following initial MRI did not have a significant effect on reducing time to cervical collar removal or overall hospital length of stay. In addition, in 3 of 6 cases (50.0%) in which surgical fixation was required, MRI detected ligamentous and/or bony injury while FE radiography was normal.Level of Evidence This study contributes Level 2b scientific evidence consistent with a well-designed cohort or case-control analytic study.https://tsaco.bmj.com/content/8/1/e001016.full |
| spellingShingle | Jeff F Zhang Richard D Thomas Janet Umenta Adil Ali Renee Reynolds Phillip Benson Ham Ravi Piryani Muhammad Izhar Brian Wrotniak Anil K Swayampakula Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury Trauma Surgery & Acute Care Open |
| title | Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury |
| title_full | Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury |
| title_fullStr | Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury |
| title_full_unstemmed | Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury |
| title_short | Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury |
| title_sort | cervical spine flexion extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury |
| url | https://tsaco.bmj.com/content/8/1/e001016.full |
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