MRI IN THE ASSESSMENT OF THE SUPPORTIVE SOFT TISSUES OF THE CERVICAL-SPINE IN ACUTE TRAUMA IN CHILDREN

We carried out a retrospective analysis of imaging and clinical findin gs in 52 children with a history of cervical spinal trauma. No patient had evidence of a fracture on plain films or CT. All had MRI at 1.5 T because of persistent or delayed symptoms, unexplained findings of in jury or instability, or as further assessment of the extent of soft-ti ssue injury. Clinical follow-up ranged from 6 months to 3.5 years. MRI was evaluated for its influence on therapy and outcome. MRI was posit ive in 16 (31%) of 52 patients. Posterior soft-tissue or ligamentous i njury was the most common finding in the 10 patients with mild to mode rate trauma, while acute disc bulges and longitudinal ligament disrupt ion, each seen in one case, were uncommon. MRI was superior to CT for assessment of the extent of soft-tissue injury and for identification of spinal cord injuries and intracanalicular hemorrhage in the six pat ients with more severe trauma. MRI specifically infIuenced the managem ent of all four patients requiring surgery by extending the level of p osterior stabilization. No patients with normal MRI or any of the 10 w ith radiographically stable soft-tissue injury on MRI, developed delay ed clinical or radiographic evidence of instability or deformity.