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Thoraco-lumbar 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.

 

  • 16 studies described thoraco-lumbar injuries 1-16
  • Age range: 0-4 years

Presenting features

  • Commonest presenting features were visible swelling / deformity 3,4,6-8,10,11,14,15
  • Kyphosis / kyphoscoliosis was a complication in almost half the cases 3,4,6-8,10,11,14,15
  • Neurological deficit below the level of injury was a common feature 3,4,6-11,14,15
  • One out of three with thoracic-lumbar had intracranial haemmorhage 13
  • One child (with co-existent abusive head trauma) had respiratory distress 11 
  • 2/24 children with AHT and spinal abnormalities were symptomatic, one with priapism and one with back pain 5

Injuries present

  • Musculoskeletal injuries including vertebral compression fractures (often multiple 1,2,12,13) / dislocations / subluxations affecting T3-S3 1-4,6-8,10-15, ligamentous injury 9,13
  • Spinal cord contusion or compression co-existed 3,4,6-8, 10, 11,14,15
  • There were no cases of neurological injury without musculoskeletal injury among this group 3,4,6-8, 10, 11,14,15
  • Barber described 14 children who had thoracic spinal (25 injuries), lumbar spinal (6 injuries) and sacral (2) fractures on skeletal survey 1
    • 10/14 children had associated intracranial injuries (seven of whom had retinal haemorrhages)
    • 9/14 children had additional skeletal injuries
    • Seven children had spinal injury at multiple levels
    • Thoraco-lumbar injuries were vertebral body compression fractures, one child had a dislocation injury. Multiple injuries were contiguous in six cases and non contiguous in two
    • MR was performed in four cases. No child had a spinal cord lesion, two children had spinal subdural haemorrhage
  • In a case-control study, 24/38 AHT cases had thoraco-lumbar subdural haemorrhage versus 1/70 accidental head trauma cases 5
  • A case study of a 13 month old infant had complete transection of the abdominal aorta and IVC in conjunction with injury to L1/L2 anterior longitudinal ligament 9
  • In three infants with thoraco-lumber injury, one child had T12-L1 ligamentous injury with co-existent spinal extradural haemorrhage 13

Co-existent abusive head trauma

  • 20 children had co-existent head trauma (nine described by Koumellis et al, ten by Barber) 1,11,14

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References

  1. 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]

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

  3. 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]
  4. 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]
  5. 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]

  6. Cullen JC (1975) Spinal lesions in battered babies. The Journal of Bone and Joint Surgery 57-B(3):364-366 [Pubmed]
  7. 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]
  8. Dickson RA, Leatherman KD. Spinal injuries in child abuse: Case report. The Journal of Trauma. 1978;18(12):811-812. [Pubmed]
  9. Dudley MH, Garg M. Fatal child abuse presenting with multiple vertebral and vascular trauma. Journal of Forensic Sciences. 2014;59(2):386-389 [Pubmed]

  10. 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]
  11. 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]
  12. 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]

  13. 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]

  14. 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]
  15. 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]
  16. 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]

 

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