Akbari Yasmin,  Kralik Stephen

Final Pr. ID: Paper #: 159

Cervical spine trauma, particularly at the craniocervical junction, can produce significant morbidity and mortality in the pediatric population. Although normative pediatric cervical spine CT measurements have been reported, the accuracy of these measurements for predicting ligamentous injury remains unknown. The purpose of this study is to evaluate the sensitivity and specificity of normative pediatric CT measurements for prediction of traumatic ligamentous injury at the craniocervical junction, using MRI as gold standard. Read More

Authors:  Akbari Yasmin , Kralik Stephen

Keywords:  Cervical spine, Trauma, CT

Chen Danling,  Kuehne Alexander,  Hwang James,  Tu Long,  Ehrlich Lauren,  Lisse Sean

Final Pr. ID: Poster #: CR-048

Grisel syndrome is a rare, acquired, non-traumatic rotatory subluxation of the atlantoaxial joint that typically occurs in the childhood period. It arises from cervical ligamentous laxity and instability following an infectious or inflammatory process in the head and neck, such as from an upper respiratory tract infection or from otolaryngolic surgery. The proposed pathophysiology of the disorder is infective septic emboli spreading from the posterosuperior pharynx to the upper cervical region via the pharyngovertebral vein, which connects the posterior nasopharyngeal veins with the periodontoid plexus. Patients present with neck pain, stiffness, and torticollis. Four types of atlantoaxial subluxation have been described using the Fielding classification system: type 1: rotation of the atlas on the axis without anterior displacement; type 2: atlantoaxial subluxation with 3-5 mm anterior displacement; type 3: atlantoaxial subluxation with greater than 5 mm anterior displacement; and type 4: atlantoaxial subluxation with posterior displacement. Permanent deformation and severe neurologic sequelae may result in the absence of timely intervention.
A 11-year-old male patient presented to the hospital with a two-week-history of severe postoperative neck pain, stiffness, headache, jaw pain, trismus, and anorexia after undergoing elective outpatient adenotonsillectomy. Contrast-enhanced CT imaging of the neck demonstrated a 4.0 cm rim-enhancing collection in the right C1-C2 prevertebral space extending into the right atlantoccipitalatlantooccipital and atlantoaxial joints consistent with prevertebral abscess formation. Additional imaging findings included atlantoaxial rotation and anterior subluxation of C1 on C2 up to 9 mm. MR of the cervical spine demonstrated evidence of prevertebral space infection, osteomyelitis of C1 and the C2 odontoid process, and rotatory and anterior atlantoaxial subluxation. Findings met criteria for Fielding type III rotatory atlantoaxial dislocation and Grisel’s syndrome. While the patient initially received conservative treatment with an extended intravenous antibiotics course of intravenous antibiotics and application of a hard collar, follow-up imaging demonstrated worsening infection, increased atlantoaxial subluxation, and central canal stenosis at C1-C2. He consequently underwent neurosurgical decompression and occipital-cervical fusion with full recovery of neurologic function. Read More

Authors:  Chen Danling , Kuehne Alexander , Hwang James , Tu Long , Ehrlich Lauren , Lisse Sean

Keywords:  Infection, Cervical Spine, Atlantodental

Intwala Devanshi,  Colglazier Roy,  Kang Paul,  Gridley Dan,  Connell Mary

Final Pr. ID: Poster #: SCI-003

Understanding normal parameters of pediatric cervical spine is imperative for early detection of cervical spine injury by computed tomography (CT) post trauma. Young children have a higher biomechanical fulcrum, incomplete ossification, and increased soft tissue laxity which minimizes anatomical distortion on CT [1,2]. The first part of this two part study aims to establish normal cervical joint spaces measurements in non-traumatic pediatric population with particular attention to the lateral atlantodental interval (ADI). Read More

Authors:  Intwala Devanshi , Colglazier Roy , Kang Paul , Gridley Dan , Connell Mary

Keywords:  Cervical spine, Atlantodental, Normal parameters

Germaine Colton,  Richards Allyson,  Tocchio Shannon,  Welch Kathryn,  Ku Elliot,  Martinez Sam

Final Pr. ID: Poster #: EDU-057

The incidence of cervical spine injuries is much less common in pediatric patients compared to their adult counterparts; however, these injuries result in more severe morbidity and mortality in the pediatric population, with increased rates of permanent neurological damage and death not uncommon. Understanding the physiology and anatomy as well as the clinical presentation of different pathologies is an essential skill when evaluating cervical spine injuries. Imaging the pediatric population presents challenges with variant anatomy and unique injury presentations on imaging. Here, we establish a search pattern for cervical spine imaging and review common pitfalls radiologists will encounter when reviewing cervical spine imaging in the setting of trauma.

CONTENT ORGANIZATION:
1) Epidemiology of pediatric cervical spine injuries.
2) Overview of the pediatric cervical spine with focus on developmental anatomy, common variants and physiologic considerations.
3) Review of search pattern considerations for cervical spine imaging.
4) Imaging examples of traumatic cervical spine injuries with illustration of critical findings and avoidable pitfalls.
5) Brief review of the role of the radiologist when reviewing cervical spine injuries.

SUMMARY:
This exhibit will provide education on important anatomy, imaging findings and pitfalls to avoid when reviewing cervical spine trauma imaging in pediatric patients. Teaching points will include:
1) Normal versus variant anatomy of the cervical spine.
2) Vital anatomical locations to review in the setting of cervical spine injury.
3) Detection of imaging features significant for cervical spine injuries using a wide variety of unique cases.
4) Effectively identifying and reporting the type and extent of the injury. Read More

Authors:  Germaine Colton , Richards Allyson , Tocchio Shannon , Welch Kathryn , Ku Elliot , Martinez Sam

Keywords:  Cervical Spine Injury, Anatomy, Pitfalls