Purpose: To evaluate the therapeutic relevance of MR imaging of suspected thoracic and lumbar spinal injury in children without the presence of neurological findings, but with persistent back pain.
Methods and Materials: For 52 children, between the ages of 6 and 16, with clinically suspected traumatic spinal injury initial AP and lateral view plain radiographs of the thoracic and lumbar spine were performed. None of the children had neurological findings but all had back pain for longer than 24 hours. In 26 patients, including 18 with detected spinal lesions on plain radiographs, native MRI followed 1 to 11 days after initial series. Sagittal T1W, T2W and STIR sequences were used. Axial T1W, T2W were added if an abnormality was seen on sagittal views. Three to six months later a clinical and radiographic follow-up is performed. In a review of plain radiographs and MR images, findings are compared and correlated to therapy.
Results: Findings in radiographs and MRI corresponded in 12 of 26 cases including only one patient without any injury despite persisting back pain. In 7 patients with plain radiographs judged normal, MRI revealed injuries such as vertebral edema (6), endplate irregularity (5) and paraspinal tissue affection (1). Six patients with injury such as pathologic anterior wedging (3), vertebral body compression (1), endplate irregularity (2) and fracture of spinous processes (1) found in initial radiographs, showed normal MRI. Changes in therapy due to MRI were found in 7 cases, 2 for over- and 5 for underestimation of findings in plain radiographs.
Conclusion: MR imaging reveals relevant information about the extend of spinal injury in children without neurological findings. Persistent back pain indicates the need for MR imaging to clarify the extent of the spinal injury. Children might benefit from additional therapy as well as from renunciation of therapy if MR imaging is performed.
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