Flexion-extension cervical spine radiography in pediatric blunt trauma

Ligamentous cervical injury may not be apparent when viewed with static cervical spine radiography (CSR). Dynamic (flexion-extension) views of the cervical spine may aid in the identification of such injury. A retrospective descriptive study was carried out between July 1, 1990, and June 30, 1994, in an academic emergency department averaging 60, 000 patient visits (of which 20% are pediatric) per year. The subjects were pediatric blunt trauma patients, 0-18 years of age. CSR was performed in the static (lateral, anteroposterior, odontoid) and dynamic (flexion and extension) views. One hundred thirty-seven patients (53% male; mean age, 12.9 years) met entry criteria. Mechanisms of injury included motor vehicle accident (57 patients, 43%), fall from a height (56 patients, 42%), and direct trauma (20 patients, 15%). Indications for CSR included a traumatic mechanism, the complaint of neck pain, and posterior midline neck tenderness on examination in all cases; abnormal static CSR was also an indication in 40 cases (30%). Results of static CSRs were normal in 93 patients (70%), all of whom had a normal dynamic CSR. Static CSRs were abnormal in 40 patients (30%), of whom 33 had a normal dynamic CSR. The 7 patients (5%) with an abnormal dynamic CSR had disruption of the lines of cervical contour (6), and/or reversal of Iordotic curve (2) noted on the static CSR. No patient required invasive spine surgery, and all were discharged with a satisfactory neurologic outcome after hospital admission. No complications of dynamic CSR use occurred. Among patients who are alert and communicative, dynamic CSR is safe and assists in the evaluation of pediatric blunt neck trauma when patients present with pain, midline tenderness, and abnormal static CSR.