title: Radiography of cervical spine injury in children: are flexion-extension radiographs useful for acute trauma?
abstract: OBJECTIVE
  We assessed the role of cervical spine flexion-extension radiographs in the acute evaluation of pediatric trauma patients.
  
  
  METHODS
  We performed a retrospective review of all pediatric trauma patients who underwent static cervical spine radiography followed by flexion-extension radiography during a 22-month period. We reviewed the mechanism of injury, physical examination findings, and patient age, and tabulated the results of initial and follow-up imaging studies.
  
  
  RESULTS
  Two hundred forty seven children (age range, 1.6-18 years; mean age, 11.5 years) with a history of trauma underwent cervical spine radiography followed by flexion-extension radiography. Static cervical spine radiographs revealed normal findings in 224 patients (91%). Flexion-extension radiographs revealed normal findings for all patients with normal findings on cervical spine radiographs. Of 23 children (9%) with abnormal findings on static cervical spine radiographs, seven (30%) had congenital abnormalities visible on flexion-extension radiographs; 10 (43%) had traumatic injuries including fracture, subluxation, or soft-tissue swelling; two (9%) had instability; and six (26%) had questionable abnormalities that were noted on static cervical spine radiographs. In four patients (66%) with abnormal findings on static cervical spine radiographs, flexion-extension radiographs were helpful in ruling out abnormality.
  
  
  CONCLUSIONS
  In children with a history of trauma and normal findings on static cervical spine radiographs, additional flexion-extension radiographs are of questionable use.
authors.affiliation: Children's Radiologic Institute, Children's Hospital of Columbus, OH 43205, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Dwek
authors.forename: C B
authors.initials: CB
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D012189:Retrospective Studies