Child abuse presenting as a thoracolumbar spinal fracture dislocation: a case report

A child sustained a traumatic thoracolumbar spinal fracture--dislocation with cord compression. A court confirmed the diagnosis of child abuse. There was no history of trauma, and the diagnosis of child abuse was missed by the physicians who first saw the child. Spinal injuries in child abuse are uncommon. They may be symptomatic or asymptomatic, stable or unstable, or occur with or without bony changes on the x-rays. Injuries without a history of trauma may be overlooked if asymptomatic. Radiologic skeletal surveys in suspected abuse should include a minimum of two views of the spine even if the child has no symptoms referrable to the spine. Conversely, a traumatic cause should be considered whenever there is spinal cord injury without vertebral injury. Having a high index of suspicion for abuse while remembering that pediatric spinal injuries may occur in the context of normal x-rays will decrease the likelihood of missed diagnosis, repeated abuse, or complications from delayed immobilization of unstable injuries.