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Magnetic resonance is an excellent modality for imaging the pediatric spine. Its successful use requires understanding both the basic physics and the sedation protocols necessary for acquiring high-resolution images. Interpreting the images accurately depends on appreciating the differences between the normal anatomy of the pediatric and the adult spine. Evaluating the images requires familiarity with the differential diagnosis of pediatric spine disease, including the most common processes (infections, neoplasms, and trauma) as well as spinal dysraphism. Despite the acknowledged usefulness of magnetic resonance imaging of the pediatric spine, controversies remain related to its safety in this age group and its limitations in diagnosing and evaluating scoliosis and tethered cord syndrome.