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

Kemp, Alison Mary ORCID:, Joshi, Amruta H., Mann, Mala K., Tempest, Vanessa, Liu, Andrea, Holden, Samantha and Maguire, Sabine Ann 2010. What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review. Archives of Disease in Childhood 95 (5) , pp. 355-360. 10.1136/adc.2009.169110

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Aim: Systematic review of: “What are the clinical and radiological characteristics of inflicted spinal injury?” Methods: Literature search of 20 electronic databases, websites, references and bibliographies (1950- 2009) using selected keywords. Critical appraisal: by two trained reviewers, (a third review, if discrepant). Inclusion criteria: primary studies of inflicted spinal injury in children <18 years, alive at presentation, with a high surety of diagnosis of abuse and sufficient detail to analyse. Results: 19 studies of 25 children were included. Twelve children, (median age 5 months) had cervical injury. In seven cases the clinical signs of spinal injury were masked by respiratory symptoms and impaired levels of consciousness, six of these children had co-existent inflicted head trauma. Twelve children with thoraco-lumbar injury (median age 13.5 months), 10/12 had lesions at T11-L2, 9/12 were fracture dislocations. All children had focal signs: 10/12 had lumbar kyphosis or thoraco-lumbar swelling, two had focal neurology. One child had cervical, thoracic and sacral injuries. Conclusions: 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 warrant a MRI. In children undergoing brain MRI for abusive head trauma, consideration should be given to including a 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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Academic & Student Support Service
Subjects: R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Publisher: BMJ Publishing Group
ISSN: 0003-9888
Last Modified: 06 Apr 2024 17:13

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