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Spinal Injuries

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


Review last updated in November 2014


Spinal injuries in children are uncommon and most arise from motor vehicle crashes or sport-related incidents in older children 1.  Abusive spinal fractures are rarely recorded, and it’s difficult to ascertain their true prevalence.  The paediatric spine is particularly susceptible to cervical injuries due to its orientation and the relative weight of the head in comparison to low muscle tone 2. This can predispose children to spinal cord injury without obvious injury to the musculoskeletal structures 3


Exciting new data relating to ligamentous injury in the cervical spine of infants subjected to abusive head trauma is a worthwhile addition to the previous literature 4. Further new data has been published relating to the yield of spinal imaging on skeletal survey 5,6


This review aims to characterise abusive spinal injury and its associated radiological features.  Since both musculoskeletal and spinal cord injuries are included, the studies were identified and reviewed during our fractures and neurological injury systematic reviews. Therefore, we originally used both the fractures and neurological injury methodology and tools


In October 2013 we combined terms from both the fractures and neurological injuries search strategies in order to create a separate search strategy specific to spinal injuries



The review seeks to answer the following review question:

  1. What are the clinical and radiological characteristics of physically abusive spinal injuries?

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  1. Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN. Spinal Injuries in Children. Journal of Pediatric Surgery. 2004;39(4):607-612 [Pubmed]
  2. Bilston LE, Brown J. Pediatric spinal injury type and severity are age and mechanism dependent. Spine. 2007;32(21):2339-2347 [Pubmed]
  3. Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 2004;55(6):1325-1343 [Pubmed]
  4. Choudhary AK, Ishak R, Zacharia TT, Dias MS. Imaging of spinal injury in abusive head trauma: a retrospective study. Pediatric Radiology. 2014;44(9):1130-1140 [Pubmed]

  5. Kleinman PK, Morris NB, Makris J, Moles RL, Kleinman PL. Yield of radiographic skeletal surveys for detection of hand, foot, and spine fractures in suspected child abuse. American Journal of Roentgenology. 2013;200(3):641-4 [Pubmed]

  6. Lindberg DM, Harper NS, Laskey AL, Berger RP; ExSTRA Investigators. Prevalence of abusive fractures of the hands, feet, spine, or pelvis on skeletal survey: perhaps "uncommon" is more common than suggested. Pediatric Emergency Care. 2013;29(1):26-9 [Pubmed]


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