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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.


Spinal Injuries 1-30

  • 870 studies reviewed
  • 30 met inclusion criteria
  • Study design:
    • 3 case-controls 6,7,17
    • 24 case series / case study 1-5,8-16,20-22,24-30
    • 3 cross-sectional 18,19,23
  • Rank abuse: Mostly rank 1-2, two rank 3 7,21 two rank 5 18,23
  • Age: range 1 – 10 years
  • Gender: Data not analysed by gender
  • Four studies evaluated the yield of skeletal surveys for spinal fractures 2,18,19,23
    • In children younger than two years old, Kleinman identified 25 fractures in 2.7% (10/365) children (mean age 10.9 months) 19
    • Karmazyn identified four spinal fractures in 0.3% (3/930) of children younger than two years old 18
    • Lindberg identified 21 fractures in 0.8% (14/1750) children less than 24 months of age 23
    • Barber identified 22 spinal fractures in 1.9% (14/75) children less than four years old 2


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  1. Agner C, Weig SG. Arterial dissection and stroke following child abuse: case report and review of the literature. Childs Nervous System. 2005;21(5):416-420 [Pubmed]
  2. Barber I, Perez-Rossello JM, Wilson CR, Silvera MV, Kleinman PK. Prevalence and relevance of pediatric spinal fractures in suspected child abuse. Pediatric Radiology. 2013;43(11):1507-15 [Pubmed]

  3. Bixby SD, Wilson CR, Barber I, Kleinman PK. Ischial apophyseal fracture in an abused infant. Pediatric Radiology. 2014;44(9):1175-1178 [Pubmed]

  4. Bode KS and Newton PO (2007) Pediatric nonaccidental trauma thoracolumbar fracture-dislocation: posterior spinal fusion with pedicle screw fixation in an 8-month-old boy. Spine 32(14):E388-E393 [Pubmed]
  5. Carrion WV, Dormans JP, Drummond DS and Christofersen MR (1996) Circumferential growth plate fracture of the thoracolumbar spine from child abuse. Journal of Pediatric Orthopaedics 16(16):210-214 [Pubmed]
  6. Choudhary AK, Bradford RK, Dias MS, Moore GJ, Boal DK. Spinal subdural hemorrhage in abusive head trauma: a retrospective study. Radiology. 2012;262(1):216-223. [Pubmed]

  7. 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]

  8. Cullen JC (1975) Spinal lesions in battered babies. The Journal of Bone and Joint Surgery 57-B(3):364-366 [Pubmed]
  9. Diamond P, Hansen CM and Christofersen MR (1994) Child abuse presenting as a thoracolumbar spinal fracture dislocation: A case report. Pediatric Emergency Care 10(2):83-86 [Pubmed]
  10. Dickson RA, Leatherman KD. Spinal injuries in child abuse: Case report. The Journal of Trauma. 1978;18(12):811-812. [Pubmed]
  11. Dudley MH, Garg M. Fatal child abuse presenting with multiple vertebral and vascular trauma. Journal of Forensic Sciences. 2014;59(2):386-389 [Pubmed]

  12. Feldman KW, Avellino AM, Sugar NF and Ellenbogen RG (2008 ) Cervical spinal cord injury in abused children. Pediatric Emergency Care 24(4):222-227 [Pubmed]
  13. Gabos PG, Tuten HR, Leet A and Stanton RP (1998) Fracture-dislocation of the lumbar spine in an abused child. Pediatrics 101:473-477 [Pubmed] [Article]
  14. Ghatan S, Ellenbogen RG. Pediatric spine and spinal cord injury after inflicted trauma. Neurosurgery Clinics of North America. 2002;13(2):227-233 [Pubmed]
  15. Gille P, Bonneville JF, Francois JY, Aubert D, Peltre G and Canal JP (1980) Fracture des pédicules de l'axis chez un nourrisson battu (Fracture of the pedicles of the axis in a battered infant). Chirurgie Pediatrique 21(5):343-344
  16. Gruber TJ, Rozzelle CJ. Thoracolumbar spine subdural hematoma as a result of nonaccidental trauma in a 4-month-old infant. Journal of Neurosurgery: Pediatrics. 2008;2:139-142 [Pubmed]
  17. 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]

  18. Karmazyn B, Lewis ME, Jennings SG, Hibbard RA, Hicks RA. The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? American Journal of Roentgenology. 2011;197(1):W159-W163 [Pubmed]
  19. 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]

  20. Kleinman PK and Shelton YA (1997) Hangman's fracture in an abused infant: imaging features. Pediatric Radiology 27:776-777 [Pubmed]
  21. Knox J, Schneider J, Wimberly RL, Riccio AI. Characteristics of spinal injuries secondary to nonaccidental trauma. Journal of Pediatric Orthopedics. 2014;34(4):376-381 [Pubmed]

  22. Koumellis P, McConachie NS, Jaspan T. Spinal subdural haematomas in children with non-accidental head injury. Archives of Disease in Childhood. 2009;94(3):216-219.[Pubmed]
  23. 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]

  24. Oral R, Rahhal R, Elshershari H and Menezes AH (2006) Intentional avulsion fracture of the second cervical vertebra in a hypotonic child. Pediatric Emergency Care 22(5):352-354 [Pubmed]
  25. Piatt JH, Jr and Steinberg M (1995) Isolated spinal cord injury as a presentation of child abuse. Pediatrics 96:780-782 [Article]
  26. Renard M, Tridon P, Kuhnast M, Renauld JM and Dollfus P (1978) Three unusual cases of spinal cord injury in childhood. Paraplegia 16:130-134 [Pubmed]
  27. Rooks VJ, Sisler C and Burton B (1998) Cervical spine injury in child abuse: report of two cases. Pediatric Radiology 28(3):193-195 [Pubmed]
  28. Sieradzki JP and Sarwark JF (2008) Thoracolumbar fracture-dislocation in child abuse: Case report, closed reduction technique and review of the literature. Pediatric Neurosurgery 44(3):253-257 [Pubmed]
  29. Thomas NH, Robinson L, Evans A, Bullock P. The floppy infant: a new manifestation of nonaccidental injury. Pediatric Neurosurgery. 1995;23(4):188-191 [Pubmed]
  30. Tran B, Silvera M, Newton A and Kleinman PK (2007) Inflicted T12 fracture-dislocation: CT/MRI correlation and mechanistic implications. Pediatric Radiology 37(11):1171-1173 [Pubmed]


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