Suspected paediatric C-spine fracture: should MRI follow negative CT?

Takeaway

• In this large series of children with suspected cervical spine (C-spine) injury (CSI), none with normal cervical CT had unstable injury on MRI.
• Authors propose algorithm, saying, “These findings support the notion that in the setting of a normal CT, cervical collar removal is safe, and MRI is unnecessary for this purpose.”

Why this matters

• For some obtunded children with normal cervical CT, the Pediatric Cervical Spine Study Group recommends MRI.
• Supporting evidence is low-quality.
• Newer CTs deliver good detail.
• MRI acquisition itself involves risk.

Key results

• C-spine fractures found in 51 children on CT, 56 on MRI.
• Of the 5 with fractures undetected on CT, 1 was unstable; CT had detected ligamentous injury.
• 72.4% (160 children) had normal CT.
  • Of those, 76 (47.5%) had stable injury on MRI, mostly ligamentous.
  • No child with normal CT was clinically unstable or had unstable injury on MRI.
• 9.5% (21 children) had stable injuries on CT.
  • Of those, 4 were deemed unstable on MRI; none required surgical or halo stabilisation.
• Similar results in multiple subgroup analyses.

Study design

• Retrospective single-centre study of children who underwent cervical CT and MRI for suspected C-spine trauma (n=221).
• Outcomes: CT/MRI discordance.
• Funding: None.

Limitations

• Single-centre study.