Lumbar spine injury in a pediatric population: difficulties with computed tomographic diagnosis.

Thirty-five children with lumbar spine injuries were evaluated with computed tomography and plain radiography following blunt trauma. The majority of these children (31) were injured in motor vehicle crashes; most of them (27 of 35, 77%) were restrained by lap-styled safety belts. The other mechanisms of injury included motor vehicle crashes involving a pedestrian (2), a fall (1), and a crush (1). The types of injuries encountered were subluxation or distraction combined with fracture in 18; fracture only in 13; and distraction only in four. Abnormalities were not detected with thick-section computed tomographic (CT) scans in 20 (57%) of the cases. Children involved in motor vehicle crashes are at high risk for lumbar spine injuries, because the sudden deceleration forces may cause hyperflexion, resulting in vertebral body compression or interspinous ligament disruption. Lumbar spine radiographs are necessary in all cases with suspected lumbar spine injury because the abnormality may be missed by thick-section CT scanning and may not be detected even with complementary thin sections.