Advanced Cervical Spine Imaging in Abusive Head Trauma: An Update on Recent Literature and Future Directions

Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT)

“… Abused have increased risk of vertebral fractures at thoraco (OR = 2.97) and lumbar (OR = 1.67) level. Not reported Abused with spinal cord/vertebral injury are less likely to be admitted with cervical vertebra column fractures compared with non-abused children (OR = 0.51) Henry et al, 2018 [ 43 ] 74 AHT and 14 accidental head trauma (<2 y) Cervical 23% of AHT and 1.3% of accidental head trauma had spinal extra-axial haemorrhage. 9% of AHT and 6% of accidental head trauma had ligamentous injury.…”

“…MRI was performed on 91 patients, and only two were positive for subdural blood collections [ 44 ]. In the study from Henry et al (2018) on 74 AHT and 14 accidental injury head trauma children under the age of 2, who underwent cervical MRI or CT for causes other than motor vehicle crash, spinal extra-axial haemorrhage was detected in up to 23% in those with AHT as opposed to only 1.3% in those accidentally injured [ 43 ].…”

“…The percentage with cervical spine injury was reported to be 8/56 while ligamentous injuries were seen in 2/8 (25%). Finally, when Oh et al (2017) studied the results form 91 abused patients (under the age of 9 years old) with cervical MRI, 13 (14%) were positive for ligamentous injuries [ 44 ], according to Henry et al’s study from 2018, where ligamentous injuries were up to 9% in AHT and 6% in those accidentally injured when cervical spinal cord is imaged by MRI or CT [ 43 ].…”

“…Of these, 11 (19%) had co-occurring spinal SDH). No Hong et al, 2019 [ 53 ] Case report of a 5-month-old boy Spinal SDH from T4 to L5 Yes Yes Henry et al, 2018 [ 43 ] 74 AHT and 14 accidental head trauma (<2 y) 23% of AHT and 1.3% of accidental head trauma had extra-axial haemorrhage Yes (87%) No Oh et al, 2017 [ 44 ] 91 abuse trauma (<9 y, ma 6 mo) 2/91 had SDH, 4 had spinal cord injuries Not reported Yes, but not exclusively Agarwal et al, 2016 [ 52 ] Case report of a 6-month-old girl Spinal SDH from thoracolumbar junction to the sacrum with mild mass effect Yes Yes Jacob et al, 2016 [ 46 ] 89 AHT (<5 y, ma 9.1 mo) Overall spinal cord injuries: 69% (67% ligamentous, 18% SDH) Yes No Kandom et al, 2014 [ 16 ] 38 AHT and 26 accidental head trauma and 10 undefined-head trauma (0.6 mo–22.6 mo, ma 5.5 mo) 1 child had intrathecal haemorrhage 2 children had spinal cord injuries Yes Yes Choundhary et al, 2014 [ 47 ] 67 AHT and 46 accidental head trauma and 70 non-traumatic (all <48 months, ma 4 mo, 15 mo, 14 mo, respectively) 48% of AHT vs 2% of accidental head trauma had SDH (all in association with intracranial SDH). None of the non-traumatic had SDH.…”

Understanding the importance of spinal injury in abusive head trauma (AHT)

“…Multiple societies have recommended MR imaging of the entire spine in cases of AHT, including a recently published consensus statement on AHT supported by multiple societies [5]. But the practice of MR imaging of the spine in AHT varies across institutions, ranging from 4.3% to 84.3% [6]. The practice also varies regarding the extent of MR spinal imaging, from none, to cervical, to entire spine.…”