What unique anatomic features of the immature cervical spine can lead to confusion during the evaluation of cervical radiographs following spine trauma

Ten anatomic features of the pediatric cervical spine commonly cause confusion during spine trauma evaluation (Fig. 44-2).

Figure 44-2. Ten unique features of the pediatric cervical spine that can cause confusion during the trauma evaluation: (1) the apical ossification center can be mistaken for a fracture; (2) the synchondrosis at the base of the odontoid can be mistaken for a fracture; (3) vertebral bodies appear rounded-off or wedged, simulating a fracture; (4) secondary centers of ossification at the tips of the spinous processes can be mistaken for a fracture; (5) the odontoid may angulate posteriorly in 4% of children; (6) C2-C3 pseudosubluxation (can be assessed with Swischuk's line); (7) the ossification center of the anterior arch of C1 may be absent in the first year of life; (8) the atlantodens interval may be as wide as 4.5 mm and still be normal; (9) the width of the prevertebral soft tissues varies widely, especially with crying, and may be mistaken for swelling; and (10) horizontal facets in young children can be mistake for a fracture. (From Flynn JM. Spine trauma in the pediatric population. Spine State Art Rev 2000;14:249-62, with permission.)

Figure 44-1. Magnetic resonance image of a fracture-dislocation of the spine occurring in a 10-month-old infant who was the victim of child abuse. The image reveals cord compression in this patient with incomplete paraplegia. (From Akbarnia BA. Pediatric spine fractures. Orthop Clin North Am 1999;30:531, with permission.)

Figure 44-1. Magnetic resonance image of a fracture-dislocation of the spine occurring in a 10-month-old infant who was the victim of child abuse. The image reveals cord compression in this patient with incomplete paraplegia. (From Akbarnia BA. Pediatric spine fractures. Orthop Clin North Am 1999;30:531, with permission.)

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