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Lumbar spine injury in a pediatric population: difficulties with computed tomographic diagnosis
R B Glass1, C J Sivit, P F Sturm
1Department of Diagnostic Imaging and Radiology and Pediatrics, Children's National Medical Center, Washington, DC.
Insights
Computed tomography (CT) scans missed abnormalities in over half of children with lumbar spine injuries. Plain radiography is crucial for diagnosing these injuries, especially after motor vehicle crashes.
Area of Science:
- Pediatric Traumatology
- Radiology
- Orthopedic Surgery
Background:
- Lumbar spine injuries in children can result from blunt trauma, particularly motor vehicle crashes.
- Lap safety belts are frequently associated with these injuries in pediatric occupants.
- Understanding injury patterns and diagnostic accuracy is vital for effective management.
Purpose of the Study:
- To evaluate the diagnostic utility of computed tomography (CT) and plain radiography in pediatric lumbar spine injuries.
- To identify common injury mechanisms and types in children sustaining lumbar spine trauma.
- To emphasize the importance of radiographic evaluation in suspected cases.
Main Methods:
- Retrospective review of 35 children with lumbar spine injuries.
- Evaluation using computed tomography (CT) and plain radiography.
- Analysis of injury mechanisms, injury types, and diagnostic findings.
Main Results:
- 57% of injuries were not detected by thick-section CT scans.
- Motor vehicle crashes were the predominant injury mechanism (31/35 children).
- Injuries included subluxation/distraction with fracture (18), fracture only (13), and distraction only (4).
Conclusions:
- Plain radiography is essential for diagnosing pediatric lumbar spine injuries, as CT may miss abnormalities.
- Children in motor vehicle crashes are at high risk for lumbar spine trauma.
- Radiographic assessment is necessary even when CT scans appear normal or are complemented by thin sections.
Abstract:
Thirty-five children with lumbar spine injuries were evaluated with computed tomography and plain radiography following blunt trauma. The majority of these children (31) were injured in motor vehicle crashes; most of them (27 of 35, 77%) were restrained by lap-styled safety belts. The other mechanisms of injury included motor vehicle crashes involving a pedestrian (2), a fall (1), and a crush (1). The types of injuries encountered were subluxation or distraction combined with fracture in 18; fracture only in 13; and distraction only in four. Abnormalities were not detected with thick-section computed tomographic (CT) scans in 20 (57%) of the cases. Children involved in motor vehicle crashes are at high risk for lumbar spine injuries, because the sudden deceleration forces may cause hyperflexion, resulting in vertebral body compression or interspinous ligament disruption. Lumbar spine radiographs are necessary in all cases with suspected lumbar spine injury because the abnormality may be missed by thick-section CT scanning and may not be detected even with complementary thin sections.