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What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review
  1. Alison Kemp1,*,
  2. Amrutha Joshi, Dr2,
  3. Mala Mann1,
  4. Vanessa Tempest1,
  5. Andrea Liu3,
  6. Samantha Holden3,
  7. Sabine Maguire1
  1. 1 Cardiff University, United Kingdom;
  2. 2 Gwent Healthcare Trust, United Kingdom;
  3. 3 Cardiff and Vale NHS Trust, United Kingdom
  1. Correspondence to: Alison Kemp, Child Health, Cardiff University, PO Box, Cardiff, 0, United Kingdom; kempam{at}cf.ac.uk

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.

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