Article Text

other Versions

Download PDFPDF
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}


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.

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:


Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.