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Abusive spinal injury: imaging and updates
Betul E Derinkuyu1, Marguerite M Caré2, Kathi L Makoroff3,4
1Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. betul.derinkuyu@cchmc.org.
Insights
Abusive spinal injuries in children are under-recognized but increasingly detected with MRI. Early detection of these injuries in non-accidental trauma cases improves care for abused children and their siblings.
Area of Science:
- Pediatric radiology
- Child abuse detection
- Spinal imaging
Background:
- Child physical abuse leads to significant pediatric morbidity and mortality.
- Abusive spinal injuries are historically under-recognized, challenging previous assumptions of rarity.
- Advanced imaging, particularly MRI, is crucial for identifying these injuries.
Purpose of the Study:
- To review the imaging literature on abusive spinal injury.
- To describe characteristic patterns of abusive spinal injuries.
- To outline appropriate imaging protocols for evaluating suspected cases.
Main Methods:
- Review of key imaging literature concerning abusive spinal injury.
- Analysis of typical injury patterns observed in pediatric patients.
- Discussion of current imaging practices and recommendations.
Main Results:
- Most abusive spinal injuries involve soft tissues and ligaments or manifest as intrathecal hemorrhage.
- Radiography and CT often fail to detect these subtle injuries.
- MRI has been instrumental in revealing the true prevalence of abusive spinal injuries.
Conclusions:
- Abusive spinal injuries are more common than previously thought.
- Recognizing spinal injury in non-accidental trauma is vital for timely intervention.
- Appropriate imaging, especially MRI, is essential for accurate diagnosis and improved patient management.
Abstract:
Child physical abuse has significant morbidity and mortality in the pediatric population. There is growing evidence that abusive spinal injury has been under-recognized, changing historical perceptions that these injuries are relatively uncommon. Increased utilization of MRI has been pivotal in recognizing that most abusive spinal injuries involve the soft tissues and ligaments or manifest as intrathecal blood products, which are often undetectable by radiography or CT. Detecting spinal injury in the work-up of non-accidental trauma improves management for abused children and their siblings (defined as siblings or other household members). This review highlights key points in the imaging literature of abusive spinal injury, describes typical patterns of injury, and addresses appropriate imaging practice for work-up.
