Citation

Kemp A, Joshi A, Mann M, Tempest V, Liu A, Holden S, Maguire S. Arch. Dis. Child. 2010; 95(5): 355-360.

Affiliation

Cardiff University, United Kingdom;

Copyright

(Copyright © 2010, BMJ Publishing Group)

DOI

10.1136/adc.2009.169110

PMID

19946011

Abstract

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.

Language: en