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A New Paradigm for the Management of Thoracolumbar Pediatric Spine Traumas
Aurélien Courvoisier1, Baptiste Belvisi, Romain Faguet
1From the Pediatric Orthopedic Department, Grenoble University Hospital, Joseph Fourier University, Grenoble, France.
Insights
The transient breath holding sign (TBHS) is a reliable indicator for identifying thoracolumbar spine injuries in children, guiding the need for MRI. Restricting MRI to TBHS-positive cases streamlines diagnosis and improves efficiency in pediatric spine trauma evaluation.
Area of Science:
- Pediatric Radiology
- Spine Trauma Imaging
- Clinical Diagnostics
Background:
- The transient breath holding sign (TBHS) is recognized for its association with spinal cord injuries.
- Current diagnostic strategies for pediatric spine trauma often involve multiple imaging modalities.
Purpose of the Study:
- To prospectively assess the efficacy of the TBHS in detecting thoracolumbar spine lesions in children.
- To develop an optimized MRI protocol for pediatric spine trauma.
Main Methods:
- Prospective inclusion of 198 conscious pediatric patients (5-16 years) with spine trauma.
- Evaluation of TBHS and full spine MRI for all participants.
- Analysis of MRI findings and calculation of TBHS sensitivity and specificity.
Main Results:
- TBHS demonstrated high sensitivity (92%) and specificity (83%) for detecting spinal lesions.
- X-rays missed 67% of vertebral injuries identified by MRI.
- MRI revealed predominantly upper end plate injuries (90%) in the sagittal plane; spinal cord and canal injuries were absent.
Conclusions:
- The TBHS is a valuable clinical tool for pediatric spine trauma assessment.
- MRI should be reserved for patients with a positive TBHS.
- A single T2 STIR sagittal MRI sequence is sufficient for diagnosis, potentially replacing conventional X-rays.
Objectives:
The transient breath holding sign (TBHS) is a clinical sign often associated with magnetic resonance imaging (MRI) spine traumatic lesions. The aims of this study were to prospectively evaluate the TBHS in the detection of thoracolumbar lesions in a large cohort of children and to establish a comprehensive strategy on the use of MRI in spine traumas in children.
Study Design:
All conscious 5- to 16-year-old patients admitted for a spine trauma in our institution were prospectively included in the study. All patients were asked for the TBHS and underwent a full spine MRI. Sensitivity and specificity of the TBHS were derived from the confusion matrix. All MRI lesions were analyzed and classified.
Results:
One hundred ninety-eight patients were included. The sensitivity of the TBHS was 92%, the specificity was 83%, the positive predictive value was 83%, and the negative predictive value was 91%. The x-rays missed 67% of the vertebrae injured in the MRI. The MRI lesions consisted in an upper end plate injury, in the sagittal plane only, in 90% of the cases. The vertebral canal and the spinal cord were never injured.
Conclusions:
This study confirms that the TBHS is a relevant clinical tool that should be added in the routine questionnaire after any trauma at admission. Magnetic resonance imaging should be restricted to patients with a TBHS positive at admission. A single T2 Short T1 Inversion Recovery (STIR) sagittal sequence seems sufficient to make the diagnosis and could replace the use of standard x-rays in pediatric spine traumas.
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