What are the relative strengths and weaknesses of plain radiographs computed tomography CT scan and magnetic resonance imaging MRI in the detection of cervical spine injuries in children

Plain radiographs are typically the initial imaging test evaluated in the spine-injured child. A cervical spine series consists of a lateral film (the most diagnostic view of the series), an anteroposterior film (AP), and an open-mouth odontoid view. Anteroposterior (AP) and lateral radiographs of the thoracic and lumbar spine are obtained if there is concern regarding injury to these spinal regions. If faced with equivocal films or an uncooperative child with a mechanism of injury or physical examination that is suspicious for spinal injury, more advanced imaging is indicated. Plain radiographs can miss up to 25% of spinal injuries in children, typically those involving unossified tissues, such as the cartilaginous endplate. CT scanning is superior for the detection of bony injuries. The use of helical CT scans for evaluation from the head to pelvis in the polytrauma patient is commonplace and is more sensitive than plain radiograph for screening for spinal injury. MRI is superior for the detection of soft tissue injuries that may be missed by plain films and CT scans.

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