Pseudosubluxation of C2 on C3 in polytraumatized children--prevalence and significance

Clin Radiol. 1999 Jun;54(6):377-80. doi: 10.1053/crad.1999.0192.


Aim: Pseudosubluxation of C2 on C3 is a recognized physiological variant in the upper cervical spine radiographs of normal children. The aim of this study was to determine the prevalence of this variant in children admitted with serious polytrauma, and to explore its significance in this setting.

Patients and methods: A retrospective review was performed of 138 patients under 16 years of age admitted with polytrauma via The Helicopter Emergency Medical Service. All patients wore hard collars and underwent immediate horizontal beam lateral cervical spine radiography. Normal and C2/C3 pseudosubluxation groups were defined using standard criteria. The two groups were compared in terms of age, presence of an endotracheal tube, injury severity, and outcome.

Results: There were 108 (78.3%) children in the normal group and 30 (21.7%) in the C2/C3 pseudosubluxation group. No significant differences in sex ratio, intubation status, injury severity, or outcome were found. Patients in the pseudosubluxation group were significantly younger.

Conclusion: In paediatric polytrauma it is essential to establish the integrity of the cervical spine promptly as this will deter unnecessary further imaging and investigation. In our study 21.7% of cases had C2/C3 pseudosubluxation on admission radiographs. We have shown that C2/C3 pseudosubluxation has no significant association with intubation status, injury severity, or outcome. We conclude that C2/C3 pseudosubluxation can be considered a benign variant even in the setting of polytrauma.

MeSH terms

  • Adolescent
  • Age Distribution
  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / injuries*
  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Joint Dislocations / diagnostic imaging*
  • Multiple Trauma / diagnostic imaging*
  • Radiography
  • Retrospective Studies
  • Risk Factors
  • Trauma Severity Indices