What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review

Abstract

Spinal injury is a potentially devastating inflicted injury in infants and young children. The published evidence base is limited. However, this case series leads us to recommend that any clinical or radiological indication of spinal injury warrants an MRI. In children undergoing brain MRI for abusive head trauma, consideration should be given to including an MRI of the spine. All skeletal surveys in children with suspected abuse should include lateral views of the cervical and thoraco-lumbar spine. Further prospective comparative studies would define the discriminating features of inflicted spinal injuries.

Spinal Subdural Hemorrhage in Abusive Head Trauma: A Retrospective Study

“…Spinal injuries are an additional welldocumented feature of abusive head trauma, although a less common feature than intracranial injuries, and may include direct spinal cord injuries, nerve root injuries or avulsions, epidural and subdural hemorrhages, and spinal ligamentous injuries or bone edema or fractures ( 7,9 ). A recent autopsy study by Brennan et al ( 7 ) documented evidence of spinal column, spinal cord, and/or cervical nerve root injuries in 71% of fatal cases.…”

Imaging of skeletal injuries associated with abusive head trauma

“…c Coned down AP view of the right shoulder defines the healing clavicle fracture (arrow) as well as a proximal humeral classic metaphyseal lesion (arrowhead). Ophthalmological exam revealed bilateral retinal hemorrhages Spinal injuries Some studies report spinal injuries with coexistent subdural hematoma and other evidence of abusive head trauma [17,21,22]. We recently reported a significant correlation between spinal fractures and intracranial injury (Fig.…”

Abusive Head Trauma

“…More recent studies suggest that spine injury in non-fatal cases of AHT may be far more common than previously thought [ 32 -35 ]; in a study by Choudhary and colleagues [00], spinal canal subdural hemorrhage was present in more than 60 % of children with AHT compared with only 1 % of children with accidental TBI. Even prior to the Choudary study, a review article by Kemp and colleagues suggest that consideration be given to performing a spine MRI in all cases of AHT [ 36 ].…”