C1-C2 posterior soft-tissue injuries with neurologic impairment in children

A retrospective study of the initial lateral cervical spine radiographs (read as normal) of five multiply traumatized quadriplegic children showed a subtle widening between the spinous processes of C1 and C2. To verify the accuracy of this widening, five distances, two calculations, and four angles were defined and measured in the pathologic group and in a control group of 12 normal children. There was a significant difference (p less than 0.05) between the two groups. A widening of greater than 10 mm between the spinous processes of C1-C2 on a neutral lateral radiograph should alert the physician to an underlying spinal cord injury. The other measurements could then confine the pathology at that level.