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Other useful references

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.


  • Study of accidental spinal injury confirming that upper cervical injury is commoner in younger children with thoraco-lumbar injuries becoming more common with increasing age 1
  • One post-mortem study demonstrated that 70% of children with abusive head trauma had pathological cervical cord injuries 2. In another, a 3.5 year old child was found dead with complete fracture dislocation through L2-L3 intervertebral disc with completely disrupted anterior longitudinal ligament, haematomas in para-spinal muscles, and extradural haematoma around caudal spinal cord. This was associated with traumatic transection of the abdominal aorta 3
  • Study describing the correlation between radiology and histopathology of vertebral fractures in fatal cases of child abuse 4
  • Infants who may present with features suggestive of physical abuse including spinal injury should have differential diagnoses (e.g. Menkes disease) considered 5
  • Optimal radiological techniques are essential for the identification of spinal injury in children; currently MRI would appear to be the imaging technique of choice to identify relevant soft tissue injuries 6-9
  • Physiological anomaly a coronal cleft may be present in the vertebral body in infants in the first year of life. They are predominantly in the lumber-spine but may be mistaken for a compression fracture 10
  • Biomechanical studies have explored the failure properties of cervical spine ligaments 11 and the pattern of histiological injury following shaking in animal studies 12

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  1. Bilston LE, Brown J. Pediatric spinal injury type and severity are age and mechanism dependent. Spine. 2007;32(21):2339-2347 [Pubmed]
  2. Brennan LK, Rubin D, Christian CW, Duhaime AC, Mirchandani HG, Rorke-Adams LB. Neck injuries in young pediatric homicide victims. Journal of Neurosurgery. Pediatrics. 2009;3(3):232-239 [Pubmed]
  3. Lieberman I, Chiasson D, Podichetty VK. Aortic disruption associated with L2-L3 fracture-dislocation in a case of child abuse: a case report. The Journal of Bone and Joint Surgery. 2010;92(7):1670-1674 [Pubmed citation only]
  4. Kleinman PK, Marks SC. Vertebral body fractures in child abuse. Radiologic-histopathologic correlates. Investigative Radiology. 1992;27(9):715-722 [Pubmed]
  5. Hill SC, Dwyer AJ, Kaler SG. Cervical spine anomalies in Menkes disease: a radiologic finding potentially confused with child abuse. Pediatric Radiology. 2012;42(11):1301-4 [Pubmed]

  6. Henry M, Riesenburger RI, Kryzanski J, Jea A, Hwang SW. A retrospective comparison of CT and MRI in detecting pediatric cervical spine injury. Child's Nervous System. 2013;29(8):1333-8 [Pubmed]

  7. Kadom N, Khademian Z, Vezina G, Shalaby-Rana E, Rice A, Hinds T. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma. Pediatric Radiology. 2014;44(7):839-848 [Pubmed]

  8. Leroux J, Vivier PH, Ould Slimane M, Foulongne E, Abu-Amara S, Lechevallier J, Griffet J. Early diagnosis of thoracolumbar spine fractures in children. A prospective study. Orthopaedics & Traumatology: Surgery & Research. 2013;99(1):60-65 [Pubmed]

  9. Ulbrich EJ, Carrino JA, Sturzenegger M, Farshad M. Imaging of acute cervical spine trauma: when to obtain which modality. Seminars in Musculoskeletal Radiology. 2013;17(4):380-388 [Pubmed]

  10. Doberentz E, Madea B, Müller AM. Coronal clefts in infants - rare differential diagnosis of traumatic injuries of vertebral bodies in battered children. Legal Medicine. 2014;16(6):333-336 [Pubmed]

  11. Trajkovski A, Omerovi? S, Hribernik M, Prebil I. Failure properties and damage of cervical spine ligaments, experiments and modeling. Journal of Biomechanical Engineering. 2014;136(3):031002 [Pubmed]

  12. Finnie JW, Blumbergs PC, Manavis J, Vink R. Pattern of cerebrospinal immediate early gene c-fos expression in an ovine model of non-accidental head injury. Journal of Clinical Neuroscience. 2013;20(12):1759-1761 [Pubmed]


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