Diagnostic yield of cervical radiographs in infants with deformational plagiocephaly

Background: When evaluating infants with deformational plagiocephaly, cervical spine radiographs are often acquired along with skull radiographs to exclude segmentation and fusion anomalies as the cause of associated torticollis. The diagnostic yield of cervical spine radiographs has not been evaluated in this clinical setting. Methods: The authors retrospectively reviewed the charts of all patients who were referred to the University of Texas Southwestern School of Medicine, Children's Medical Center (Dallas, Texas) with deformational plagiocephaly and torticollis and underwent cervical radiography (anteroposterior and lateral views) from 2010 to 2012. The authors reviewed the radiology reports, and a single experienced pediatric neuroradiologist again reviewed all radiographic studies in which the interpreting radiologist had suggested any bony or soft-tissue abnormality. Patient demographics, perinatal data, and physical examination findings were collected, and descriptive statistics were calculated. Results: There were 730 patients with deformational plagiocephaly and torticollis; 49 of 730 reports (6.7 percent) described an abnormality. Of those with abnormal radiologic reports that were abnormal, 23 (47 percent) described osseous abnormalities, 20 (41 percent) described nonosseous deformities, and six (12 percent) described both. Follow-up studies (computed tomography, magnetic resonance imaging, and repeated radiography) of those with abnormalities showed three infants with true upper cervical spine anomalies that might lead to instability of the cervical spine. Conclusions: There is a low diagnostic yield in ordering cervical radiographs in most patients with deformational plagiocephaly. Although the radiation exposure is low, cervical radiographs add additional cost and may not be warranted as a routine practice in this clinical setting.