The diagnostic potential of cone beam computed tomography for cervical spine injuries in children: a review of two reports

Abstract

Compared to multiaxial computed tomography, the cone beam computed tomography has its benefits in terms of higher resolution imaging, including the construction of a 3D image, and in terms of several fold lower radiation exposure. The duration of scanning of less than 1 minute and the possibility to place a patient in the sitting position allow for the use of this method in various fields of stomatology, maxillofacial surgery, as well as in traumatology for the assessment of limb injuries. The paper presents our experience with the cone beam computed tomography as a single method for radiation diagnostics in children with cervical spine injuries. The first case is an example of the use of this method for primary diagnosis and subsequent follow-up of the restoration of the atlantoaxial position in a 9-year old child with rotatory subluxation of the atlant. To clarify the type of the injury, we combined and compared the axial planes of the 1st and 2nd cervical vertebrae. In the second case, we explored the possibility to assess the restoration of the bone structure and mutual position of the upper cervical vertebrae with the images obtained by cone beam computed tomography in a 9-year old girl with the Down's syndrome, who had been operated due to a cervical spine injury. The analysis of the cone beam computed tomography images from the first clinical case delineates the prospects of the method in the diagnostics of the atlant rotation subluxation in school-age children. Evaluation of the images obtained during the examination of the second clinical case has identified some disadvantages of the cone beam computed tomography, namely: 1) there is no way to control the fixed patient position, 2) limitations of the software to suppress artifacts arising from the metal construction, which leads to advanced image blurring and flatness, significantly hindering the identification of abnormalities.