Check that neck: Cervical spine imaging

Case presentation

A 12-month-old female presents following a motor vehicle accident. The child was reportedly secured in a rear car seat; however, the child was found outside of the vehicle lying on the pavement. The two-vehicle crash occurred at a high rate of speed (70–80 miles/hour), and there was considerable damage to both vehicles but no deaths at the scene.

In the Emergency Department, the child has a waxing and waning mental status, with her Glasgow Coma Scale (GCS) score varying between 8 and 12. She has some bruising to the right side of the forehead without crepitus or step-offs and her face seems uninjured; she is in a cervical collar applied by Emergency Medical Services prior to arrival. Examination of the neck shows no abnormalities, but the child seems to not want to move her neck and there appears to be some pain to palpation of cervical vertebrae, although it is hard to determine the exact spinal level. She is not moving her left leg well and there is swelling of the thigh.

Imaging considerations