Utility of STIR MRI in pediatric cervical spine clearance after trauma

Clinical article

View More View Less
  • 1 Department of Neurosurgery, Tufts Medical Center, Floating Hospital for Children, Boston, Massachusetts;
  • | 2 Department of Orthopedic Surgery, Shriner's Hospital for Children, Philadelphia, Pennsylvania; and
  • | 3 Department of Neurosurgery, Texas Children's Hospital, Houston, Texas
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Although MRI with short-term T1 inversion recovery (STIR) sequencing has been widely adopted in the clearance of cervical spine in adults who have sustained trauma, its applicability for cervical spine clearance in pediatric trauma patients remains unclear. The authors sought to review a Level 1 trauma center's experience using MRI for posttraumatic evaluation of the cervical spine in pediatric patients.

Methods

A pediatric trauma database was retrospectively queried for patients who received an injury warranting radiographic imaging of the cervical spine and had a STIR-MRI sequence of the cervical spine performed within 48 hours of injury between 2002 and 2011. Demographic, radiographic, and outcome data were retrospectively collected through medical records.

Results

Seventy-three cases were included in the analysis. The mean duration of follow-up was 10 months (range 4 days–7 years). The mean age of the patients at the time of trauma evaluation was 8.3 ± 5.8 years, and 65% were male. The majority of patients were involved in a motor vehicle accident. In 70 cases, the results of MRI studies were negative, and the patients were cleared prior to discharge with no clinical suggestion of instability on follow-up. In 3 cases, the MRI studies had abnormal findings; 2 of these 3 patients were cleared with dynamic radiographs during the same admission. Only 1 patient had an unstable injury and required surgical stabilization. The sensitivity of STIR MRI to detect cervical instability was 100% with a specificity of 97%. The positive predictive value was 33% and the negative predictive value was 100%.

Conclusions

Although interpretation of our results are diminished by limitations of the study, in our series, STIR MRI in routine screening for pediatric cervical trauma had a high sensitivity and slightly lower specificity, but may have utility in future practices and should be considered for implementation into protocols.

Abbreviations used in this paper:

GCS = Glasgow Coma Scale; MRI = magnetic resonance imaging (used in this study to refer specifically to STIR sequences); STIR = short T1 inversion recovery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Ackland HM, , Cooper DJ, , Malham GM, & Stuckey SL: Magnetic resonance imaging for clearing the cervical spine in unconscious intensive care trauma patients. J Trauma 60:668673, 2006

    • Search Google Scholar
    • Export Citation
  • 2

    Akbarnia BA: Pediatric spine fractures. Orthop Clin North Am 30:521536, 1999

  • 3

    Anderson RC, , Scaife ER, , Fenton SJ, , Kan P, , Hansen KW, & Brockmeyer DL: Cervical spine clearance after trauma in children. J Neurosurg 105:5 Suppl 361364, 2006

    • Search Google Scholar
    • Export Citation
  • 4

    Benzel EC, , Hart BL, , Ball PA, , Baldwin NG, , Orrison WW, & Espinosa MC: Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. J Neurosurg 85:824829, 1996

    • Search Google Scholar
    • Export Citation
  • 5

    Birney TJ, & Hanley EN Jr: Traumatic cervical spine injuries in childhood and adolescence. Spine (Phila Pa 1976) 14:12771282, 1989

  • 6

    Blauth M, , Schmidt U, , Otte D, & Krettek C: Fractures of the odontoid process in small children: biomechanical analysis and report of three cases. Eur Spine J 5:6370, 1996

    • Search Google Scholar
    • Export Citation
  • 7

    Bley TA, , Wieben O, , François CJ, , Brittain JH, & Reeder SB: Fat and water magnetic resonance imaging. J Magn Reson Imaging 31:418, 2010

  • 8

    Brockmeyer DL, , Ragel BT, & Kestle JR: The pediatric cervical spine instability study. A pilot study assessing the prognostic value of four imaging modalities in clearing the cervical spine for children with severe traumatic injuries. Childs Nerv Syst 28:699705, 2012

    • Search Google Scholar
    • Export Citation
  • 9

    Flynn JM, , Closkey RF, , Mahboubi S, & Dormans JP: Role of magnetic resonance imaging in the assessment of pediatric cervical spine injuries. J Pediatr Orthop 22:573577, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Frank JB, , Lim CK, , Flynn JM, & Dormans JP: The efficacy of magnetic resonance imaging in pediatric cervical spine clearance. Spine (Phila Pa 1976) 27:11761179, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Hoffman JR, , Mower WR, , Wolfson AB, , Todd KH, & Zucker MI: Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 343:9499, 2000

    • Search Google Scholar
    • Export Citation
  • 12

    Kokoska ER, , Keller MS, , Rallo MC, & Weber TR: Characteristics of pediatric cervical spine injuries. J Pediatr Surg 36:100105, 2001

  • 13

    Lee SL, , Sena M, , Greenholz SK, & Fledderman M: A multidisciplinary approach to the development of a cervical spine clearance protocol: process, rationale, and initial results. J Pediatr Surg 38:358362, 2003

    • Search Google Scholar
    • Export Citation
  • 14

    Muchow RD, , Resnick DK, , Abdel MP, , Munoz A, & Anderson PA: Magnetic resonance imaging (MRI) in the clearance of the cervical spine in blunt trauma: a meta-analysis. J Trauma 64:179189, 2008

    • Search Google Scholar
    • Export Citation
  • 15

    Rahimi SY, , Stevens EA, , Yeh DJ, , Flannery AM, , Choudhri HF, & Lee MR: Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus 15:6 ECP1, 2003

    • Search Google Scholar
    • Export Citation
  • 16

    Richards PJ: Cervical spine clearance: a review. Injury 36:248270, 2005

  • 17

    Scarrow AM, , Levy EI, , Resnick DK, , Adelson PD, & Sclabassi RJ: Cervical spine evaluation in obtunded or comatose pediatric trauma patients: a pilot study. Pediatr Neurosurg 30:169175, 1999

    • Search Google Scholar
    • Export Citation
  • 18

    Stiell IG, , Clement CM, , McKnight RD, , Brison R, , Schull MJ, & Rowe BH, et al.: The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 349:25102518, 2003

    • Search Google Scholar
    • Export Citation
  • 19

    Stiell IG, , Wells GA, , Vandemheen KL, , Clement CM, , Lesiuk H, & De Maio VJ, et al.: The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 286:18411848, 2001

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 734 147 4
Full Text Views 167 12 2
PDF Downloads 168 19 2
EPUB Downloads 0 0 0