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1	IMAGING OF SPINAL TRAUMA IN CHILDREN Leonard E. Swischuk, M.D. Professor of Radiology and Pediatrics Chairman, Radiology Director, Pediatric Radiology
2	TRAUMA Cervical spine injuries far more common Thoracic and lumbar injuries from more severe accidents Emphasis will be on cervical spine injuries
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6	INJURIES IN OLDER CHILDREN AND ADOLESCENTS Same as in adults
7	INJURIES IN INFANTS More common in upper cervical spine
8	SIGNS OF INSTABILITY Tear drop fracture Anterior or posterior dislocation Anterior wedging Narrow or wide disc space Posterior arch fracture Lateral mass displacement (Jefferson fracture) Open apophyseal joints Altered ring of Harris Dens fracture
9	SIGNS OF INSTABILITY (Teardrop fracture) Inferior (hyperflexion injury) Superior (hyperextension injury)
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12	NORMAL MIMICKER Ring epiphysis
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15	RING EPIPHYSIS May be avulsed
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17	SIGNS OF INSTABILITY (Anterior dislocation and narrow disc space) Hyperflexion injury Rotation injury
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20	NORMAL MIMICKER (Narrow disc space) Block vertebra
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22	SIGNS OF INSTABILITY (Anterior displacement and wide disc space) hyperextension injury
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26	SIGNS OF INSTABILITY (Wide disc space) Hyperextension injury
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31	WIDE DISC SPACE - POSTERIOR Hyperflexion injury Whiplash injury
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35	NORMAL MIMICKER (Wide disc space) C2, dens – body synchondrosis
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37	NORMAL MIMICKERS (Anterior dislocation) C2 – C3 subluxation C3 – C4 subluxation Less common
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48	SIGNS OF INSTABILITY (Posterior displacement) hyperflexion axial load burst
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53	NORMAL MIMICKERS (Posterior dislocation) Normal motion (2 mm)
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55	SIGNS OF INSTABILITY (Anterior wedging) Hyperflexion injury Axial compression load
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58	NORMAL MIMICKERS (Anterior wedging) C3, C4 common C5 less common
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66	SIGNS OF INSTABILITY (Posterior Arch Defect) Hyperextension injury Hangman fracture mechanism Fractures thin and sharp
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69	NORMAL MIMICKERS C1, C2 posterior arch defects
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80	BIZARRE Congenital anomaly
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85	BIZARRE Congenital anomaly
86	SIGNS OF INSTABILITY Lateral mass C1 displacement Jefferson fracture One side normal, other side wide
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89	NORMAL MIMICKERS Normal under 2 years Rotation Pathologic Positional
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91	NORMAL MIMICKER (Displaced lateral mass) Rotation One side wide, other side narrow
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96	SIGNS OF INSTABILITY (Increased predental distance) hyperflexion injury rotation injury os odontoideum complex
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99	NORMAL MIMICKER (Increased predental distance) Normal up to 5 mm (2-3%)
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102	PREDENTAL DISTANCE (Normal motion) Up to 2 mm with flexion
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105	SIGNS OF INSTABILITY (increased interspinous distance) hyperflexion injury
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107	SIGNS OF INSTABILITY (C1-C2 intraspinous distance increased) Hyperflexion injury
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109	NORMAL MIMICKERS Normal motion
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111	SIGNS OF INSTABILITY (Dens fracture) Anterior tilting more common Most through dens body synchondrosis
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116	NORMAL MIMICKERS Posterior tilting of the dens Lateral tilting of the dens Os odontoideum complex
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120	SIGNS OF INSTABILITY (Altered ring of Harris)
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122	SIGNS OF INSTABILITY Open “V” apophyseal joint
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125	NORMAL MIMICKERS Physiologic “V” apophyseal joint ?
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