Spinal fracture rates from NAT have been reported in <1–3% of spinal injury cases. We present a 13-month-old female who presented with signs of spinal cord injury and was found to have complete retrospondylolisthesis of T12 vertebra and multiple rib fractures in various stages of healing due to NAT. This case reports an extremely severe spinal injury due to NAT of which there are few in the literature and highlights the importance of suspicion of NAT when pediatric patients present with neurologic symptoms and spinal trauma without plausible mechanism of injury.

Objectives: To determine the patient and treatment characteristics associated with delay in post-operative radiation therapy (PORT) for patients treated surgically for head and neck squamous cell cancer (HNSCC) at our institution. Design: Single institution retrospective review Setting: Tertiary care academic medical center Participants: Patients treated surgically for HNSCC that underwent PORT between 2013-2016 Main outcomes measures: Time from surgery to initiation of PORT. Results: 140 patients met inclusion criteria. A majority did not start radiotherapy within six weeks. Factors associated with a delayed initiation of PORT included length of stay >8 days, 30-day readmission, no adjuvant chemotherapy, post-operative complications, and fragmented care. Conclusion: A majority of patients did not initiate PORT within the guideline-recommended 6 weeks. Modifiable risks factors that delay initiation of PORT were identified.