Cervical Spinal Cord Injury in Abused Children

Abstract

Five infants and toddlers who sustained cervical spinal cord injury as the result of child abuse are described. Three cases are previously unreported. Diagnosis was complicated by coexistent brain injuries and their treatments, subtle and/or evolving paralysis, and central cord syndrome, in which arm function is diminished but leg function is preserved. Definitive spinal imaging by magnetic resonance imaging (MRI), computed tomography, and plain radiographs was delayed because of life support efforts. When completed, the MRI was most sensitive to cord injury. Evidence of associated bony spinal injury was often absent or unapparent until healing occurred; 4 children had spinal cord injury without (or with minimal) radiological abnormality. The 3 children presenting to our hospital with cord injury represent 1% of the estimated cases of inflicted head injury seen during a 23-year period.

Imaging, Clearance, and Controversies in Pediatric Cervical Spine Trauma

“…2 A small case series notes that cervical spine injury in child abuse likely is rare and, when present, diagnosis may be delayed. 7 The mortality rate for children with cervical spine injury ranges from 13% to 28%. 2,5,8 Mortality is highest in younger patients and those with higher cervical spine injuries.…”

What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review

“…We included 19 small case series or case studies, published between 1975 and February 2009, representing 25 children who had sustained inflicted spinal injury 8 11 14–30. All studies ranked 1–2 for abuse, confirmed by communication with authors in two studies 28 30.…”

“…Population studies estimate that 3–8% of spinal injuries are the result of child abuse7; however, it is difficult to quantify the true scale of the problem, as many studies do not appear to consider inflicted injury as a possible cause. Studies of children who have been physically abused estimate that 1% of children who suffer abusive head trauma have coexisting spinal trauma,8 and between 1% and 3% of abusive fractures are to the vertebrae 9 10…”

Yield of Radiographic Skeletal Surveys for Detection of Hand, Foot, and Spine Fractures in Suspected Child Abuse

“…Comprehensive reviews have found that 1%-3% of abusive fractures involved the vertebrae and that 1% of children who suffer abusive head trauma have coexisting spinal trauma [7,8,15,16]. Few data are available with respect to the hands and feet, but limited reports suggest that these injuries are also very uncommonly noted on skeletal surveys [3,14,17].…”