The pediatric trauma C-spine: Is the 'odontoid' view necessary?

Chad Buhs, Marc Cullen, Michael Klein, Diana L Farmer

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background/Purpose: The 'odontoid view' is a difficult and often hazardous film to obtain in young children. The aim of this study was to determine if the transoral roentgenogram is necessary in the evaluation of the pediatric cervical spine. Methods: A retrospective, multiinstitutional review was performed of all patients 16 years of age and under with documented cervical spine injury in a large metropolitan area during the past decade. Fifty-one children with cervical spine injury were identified from the medical records at 4 hospitals. Results: The 0- to 8-year-old age group had a significantly higher incidence of upper (occiput to C3) cervical injury than the 9- to 16-year-old age group (67% v 39%; P < .05). In the 0- to 8- year-old group the initial lateral/anteroposterior radiograph made the diagnosis of cervical spine injury in 13 of 15 patients (87%), and in no patients was the transoral odontoid view used to make the diagnosis of cervical spine injury. In only 1 patient in the 9- to 16-year-old age group with a type III odontoid fracture was this view deemed useful. The overall mortality rate in this series was 7.8% with all deaths secondary to associated head injury. Conclusions: In the 0- to 8-year-old age group in whom the incidence of cervical spine injury is rare but frequently involves the upper cervical spine, the transoral odontoid roentgenogram may be of little value in the evaluation of the spine and should not be considered necessary in 'clearing' the pediatric cervical spine. An alternative evaluation of these patients would include an initial lateral and AP radiograph, followed by computed tomography scan. Copyright (C) 2000 by W.B. Saunders Company.

Original languageEnglish (US)
Pages (from-to)994-997
Number of pages4
JournalJournal of Pediatric Surgery
Volume35
Issue number6
StatePublished - Jun 2000

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Spine
Pediatrics
Wounds and Injuries
Age Groups
Incidence
Craniocerebral Trauma
Medical Records
Tomography
Mortality

Keywords

  • Cervical spine injur
  • Odontoid
  • Pediatric trauma

ASJC Scopus subject areas

  • Surgery

Cite this

The pediatric trauma C-spine : Is the 'odontoid' view necessary? / Buhs, Chad; Cullen, Marc; Klein, Michael; Farmer, Diana L.

In: Journal of Pediatric Surgery, Vol. 35, No. 6, 06.2000, p. 994-997.

Research output: Contribution to journalArticle

Buhs, Chad ; Cullen, Marc ; Klein, Michael ; Farmer, Diana L. / The pediatric trauma C-spine : Is the 'odontoid' view necessary?. In: Journal of Pediatric Surgery. 2000 ; Vol. 35, No. 6. pp. 994-997.
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abstract = "Background/Purpose: The 'odontoid view' is a difficult and often hazardous film to obtain in young children. The aim of this study was to determine if the transoral roentgenogram is necessary in the evaluation of the pediatric cervical spine. Methods: A retrospective, multiinstitutional review was performed of all patients 16 years of age and under with documented cervical spine injury in a large metropolitan area during the past decade. Fifty-one children with cervical spine injury were identified from the medical records at 4 hospitals. Results: The 0- to 8-year-old age group had a significantly higher incidence of upper (occiput to C3) cervical injury than the 9- to 16-year-old age group (67{\%} v 39{\%}; P < .05). In the 0- to 8- year-old group the initial lateral/anteroposterior radiograph made the diagnosis of cervical spine injury in 13 of 15 patients (87{\%}), and in no patients was the transoral odontoid view used to make the diagnosis of cervical spine injury. In only 1 patient in the 9- to 16-year-old age group with a type III odontoid fracture was this view deemed useful. The overall mortality rate in this series was 7.8{\%} with all deaths secondary to associated head injury. Conclusions: In the 0- to 8-year-old age group in whom the incidence of cervical spine injury is rare but frequently involves the upper cervical spine, the transoral odontoid roentgenogram may be of little value in the evaluation of the spine and should not be considered necessary in 'clearing' the pediatric cervical spine. An alternative evaluation of these patients would include an initial lateral and AP radiograph, followed by computed tomography scan. Copyright (C) 2000 by W.B. Saunders Company.",
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