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AAP Grand Rounds 4:48 (2000) Assessment of Traumatic Craniocervical Instability in ChildrenSource: Sun PP, Poffenbarger GJ, Durham S, et al. Spectrum of occipitoatlantoaxial injury in young children. J Neurosurg. 2000;93(suppl 1):2839.
In young children, most traumatic cervical spine injuries occur at the craniocervical junction. Because these injuries tend to be ligamentous rather than osseous, assessment by radiography and computed tomography (CT) is notoriously difficult. The multitude of imaging criteria for instability based on lines and ratios testifies to the intractability of this problem. Sun et al report their experience with magnetic resonance imaging (MRI) in 71 consecutive children with traumatic cervical spine injuries evaluated at the Childrens Hospital of Philadelphia. Patients were excluded from the study if they had preexisting cervical anomalies (Down syndrome). Indications for MRI were a suspicion of cervical trauma in patients who could
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