Authors (including presenting author) :
POON MY(1), TSANG BPK(2), TUNG JYL(3), KUONG E(4), CHAN JPK(1)
Affiliation :
(1) Department of Radiology, HKCH (2) Department of Physiotherapy, HCH (3) Endocrine team, Department of Paediatrics and Adolescent Medicine, HKCH (4) Department of Orthopaedics and Traumatology, HKCH
Keyword 2: :
flexion-extension cervical spine
Keyword 4: :
skeletal dysplasia
Keyword 5: :
physiotherapy
Keyword 6: :
hospital play services
Introduction :
Dynamic imaging of the cervical spine is crucial in evaluating cervical spine instability and canal stenosis in children with skeletal dysplasia. Traditionally, dynamic imaging is done by flexion-extension radiograph, which is not all the time conclusive and cannot visualize the spinal cord for compression. In Hong Kong Children’s Hospital, a sedation‑free flexion-extension cervical spine MRI protocol is developed for superior evaluation, relying on multi‑disciplinary collaboration to enhance safety, image quality and patient experience
Objectives :
The objective is to implement a safe and effective sedation‑free flexion‑extension cervical spine MRI service for children with skeletal dysplasia, using coordinated input from radiologists, endocrinologists, orthopedic surgeons, radiographers, physiotherapists and hospital play specialists to optimize dynamic assessment, patient comfort and cooperation.
Methodology :
•Clinical assessment and case selection are performed in a skeletal dysplasia joint clinic, where radiologists, together with orthopaedic surgeons and paediatric endocrinologists, endorse the need for dynamic flexion-extension cervical spine MRI. •Radiographers coordinate appointments and plan coil configuration, mattress, soft pads and positioning devices to support comfortable, safe flexion and extension while maintaining image quality. •Physiotherapists provide pre‑scan education on correct self‑positioning in flexion and extension, and assess cervical spine stability immediately before and after the MRI examination. •Hospital play specialists prepare children through medical role‑play, use of dolls and a mock scanner to familiarize them with the in‑bore environment and required “chin‑tuck” (flexion) and “look‑up” (extension) positions, coach coping strategies to keep calm and still during scanning. •During scanning, children are encouraged to actively flex and extend their neck within their tolerance, under physiotherapist guidance and radiographer supervision. No passive positioning is done. MR imaging done without the use of sedation or anaesthesia.
Result & Outcome :
•The multi‑disciplinary approach enables successful dynamic cervical‑spine MRI in young children with skeletal dysplasia without sedation, reducing the risks associated with anaesthesia in this high‑risk group. •Children gain a greater sense of control over positioning, which, together with play preparation and careful immobilization, helps minimize anxiety and motion, thereby improving cooperation. •Superior assessment of cervical stability and cord condition using MRI imaging.
