Role of flexion-extension radiographs in blunt pediatric cervical spine injury

Objective: To determine whether flexion-extension cervical spine radiograph y (FECSR) is abnormal in children who have sustained blunt cervical spine i njury (CSI) when standard cervical spine radiography (SCSR) demonstrates no acute abnormalities. Methods: This was a blinded radiographic review of 12 9 patients less than or equal to 16 years of age evaluated at an academic p ediatric trauma center during July 1990-March 1996. All patients had SCSR ( anteroposterior/lateral views) and FECSR performed for a trauma-related eve nt within seven days of injury. Results: Of 46 patients without acute abnor malities on SCSR, one patient (with final clinical diagnosis of "no CSI") h ad acute abnormalities on FECSR (95% CI = 0.06% to 11.5%). Of 50 patients w ith isolated loss of lordosis on SCSR, no patient had acute abnormalities o n FECSR (95% CI = 0% to 5.8%). The FECSR review revealed no acute abnormali ties in 75 of 83 patients (90.4%) with suspicious findings for CSI viewed o n SCSR (95% CI = 81.9% to 95.7%). Complications during FECSR were noted in one patient with transient paresthesias (0.8%) (95% CI = 0.02% to 4.2%). Co nclusions: In children who underwent acute radiographic evaluation of blunt cervical spine trauma, FECSR was unlikely to be abnormal when no acute abn ormality or isolated loss of lordosis was evident on SCSR. In a subset of p atients with suspicious findings for occult CSI on SCSR, FECSR was useful i n ruling out ligamentous instability in the acute, posttrauma setting.