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Abusive Truama of the Spine: A Pictorial Essay 2012

General Spine

David, M, Mirsky, MD
Karuna, V, Shekdar, MD, Non ASSR Member
Erin, S, Schwartz, MD, Non ASSR Member

Poster

Purpose

Central nervous system manifestations in abusive trauma (also known as non-accidental trauma or child abuse) are common. Much of the emphasis has been placed on brain imaging in the work-up for suspected abusive trauma. Pediatric spine and spinal cord injuries are rare and the number of these injuries due to abusive trauma is even smaller. However, the mortality rate and incidence of neurologic deficits in victims of abusive spine trauma are high. Additionally, the impact on the patient's family, health care system, and society is considerable. Spinal injury in the setting of abusive trauma may be easily overlooked when mechanism of injury is unclear and co-existent brain injury dominates the clinical picture. These may be compounded by the young age of the child, limited verbal skills, inability to comply with a detailed neurologic examination, and/or poor communication on the part of the caregiver, who is statistically most likely to have been the abuser. Cross-sectional imaging of the spine is frequently not a routine part of the work-up in a case of suspected abusive trauma. Our goal is to illustrate our experience with the varied injuries that may be encountered in abusive spine trauma in the pediatric population with an emphasis on MR imaging. Awareness of these often overlooked imaging findings may improve early diagnosis, intervention, and improved outcomes, as well as provide further information regarding the true extent of the inflicted injuries.

Methods & Materials

Various imaging presentations of abusive spine trauma are reviewed, including: â