Related Experiment Video
Updated: Jul 7, 2026
Calibrated Forceps Model of Spinal Cord Compression Injury
Published on: April 24, 2015
Detection of pediatric cervical spine injury
Hugh J L Garton1, Matthew R Hammer
1Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0338, USA. hgarton@umich.edu
Insights
Pediatric cervical spine injuries differ by age, with younger children experiencing more injuries at the occiput-C2 region. The National Emergency X-Radiography Utilization Study (NEXUS) protocol may be less sensitive in children under 8, necessitating tailored guidelines.
Area of Science:
- Pediatric Radiology
- Trauma Imaging
- Spinal Injury Assessment
Background:
- Adult cervical spine injury protocols may not adequately address pediatric injury patterns.
- This can lead to unnecessary radiation exposure in children.
- Pediatric-specific guidelines are needed, informed by injury location and detection methods.
Purpose of the Study:
- To evaluate the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS) criteria in pediatric cervical spine injuries.
- To determine the location of cervical spine injuries in pediatric patients.
- To compare the diagnostic yield of different imaging modalities in young children.
Main Methods:
- Retrospective review of pediatric patients with International Classification of Diseases, 9th Revision, codes for cervical spine injury (1980-2000).
- Data collected included physical findings, radiographic detection methods, and injury location.
- Sensitivity of plain X-rays and additional radiographic studies was calculated.
Main Results:
- In children under 8, NEXUS criteria missed 2 injuries (94% sensitivity), with 76% of injuries at occiput-C2.
- In children over 8, NEXUS criteria had 100% sensitivity, with 25% of injuries at occiput-C2.
- For children under 8, plain-film sensitivity was 75%, while CT scan (occiput-C3) improved sensitivity to 94%.
Conclusions:
- Younger children have a higher incidence of rostral (occiput-C2) cervical spine injuries.
- The NEXUS protocol's sensitivity may be lower in young children compared to adults.
- Limited CT scans of the upper cervical spine can enhance diagnostic yield in young children.
Objective:
In evaluating the pediatric cervical spine for injury, the use of adult protocols without sufficient sensitivity to pediatric injury patterns may lead to excessive radiation doses. Data on injury location and means of detection can inform pediatric-specific guideline development.
Methods:
We retrospectively identified pediatric patients with codes from the International Classification of Diseases, 9th Revision, for cervical spine injury treated between 1980 and 2000. Collected data included physical findings, radiographic means of detection, and location of injury. Sensitivity of plain x-rays and diagnostic yield from additional radiographic studies were calculated.
Results:
Of 239 patients, 190 had true injuries and adequate medical records; of these, 187 had adequate radiology records. Patients without radiographic abnormality were excluded. In 34 children younger than 8 years, National Emergency X-Radiography Utilization Study criteria missed two injuries (sensitivity, 94%), with 76% of injuries occurring from occiput-C2. In 158 children older than 8 years, National Emergency X-Radiography Utilization Study criteria identified all injured patients (sensitivity, 100%), with 25% of injuries occurring from occiput-C2. For children younger than 8 years, plain-film sensitivity was 75% and combination plain-film/occiput-C3 computed tomographic scan had a sensitivity of 94%, whereas combination plain-film and flexion-extension views had 81% sensitivity. In patients older than 8 years, the sensitivities were 93%, 97%, and 94%, respectively.
Conclusion:
Younger children tend to have more rostral (occiput-C2) injuries compared with older children. The National Emergency X-Radiography Utilization Study protocol may have lower sensitivity in young children than in adults. Limited computed tomography from occiput-C3 may increase diagnostic yield appreciably in young children compared with flexion-extension views. Further prospective studies, especially of young children, are needed to develop reliable pediatric protocols.
