Pediatric abusive spine trauma: a review of whole-spine imaging essentials

Area of Science:

• Pediatric Radiology
• Forensic Medicine
• Child Abuse Detection

Background:

• Abusive spinal injuries in infants can be clinically silent, posing diagnostic challenges.
• Ligamentous injury of the craniocervical junction and upper cervical spine is common in abused infants, often linked to hypoxic-ischemic brain injury.
• Thoracolumbar spine injuries, including compression fractures and extra-axial hemorrhages, are specific to abuse but frequently occult and missed on skeletal surveys.

Purpose of the Study:

• To review indications and recommendations for whole-spine imaging in suspected child abuse.
• To highlight the importance of whole-spine MRI in detecting abusive spinal injuries.
• To illustrate various types of spinal injuries associated with child abuse.

Main Methods:

• Review of literature on abusive spinal injuries in children.
• Discussion of imaging modalities, particularly MRI, for whole-spine assessment.
• Presentation of imaging examples of vertebral fractures, spinal cord injuries, and hemorrhages.

Main Results:

• Abusive spinal injuries are often clinically occult and can be missed by standard skeletal surveys.
• Whole-spine MRI is essential for detecting injuries like vertebral fractures, spinal cord injury, and spinal hemorrhage.
• Injuries may be present in the absence of cervical spine involvement, underscoring the need for comprehensive imaging.

Conclusions:

• Whole-spine MRI screening is indicated in selected cases of abusive trauma with potential for spinal injuries.
• Early and accurate diagnosis of abusive spinal injuries is critical for appropriate treatment and medicolegal purposes.
• Comprehensive imaging protocols are necessary to ensure detection of all spinal injuries in abused children.