@article{ref1,
title="What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review",
journal="Archives of disease in childhood",
year="2010",
author="Kemp, A. M. and Joshi, A. and Mann, Marilynne and Tempest, V. and Liu, Aizhong and Holden, S. and Maguire, S.",
volume="95",
number="5",
pages="355-360",
abstract="AIM: Systematic review of: &quot;What are the clinical and radiological characteristics of inflicted spinal injury?&quot; METHODS: Literature search of 20 electronic databases, websites, references and bibliographies (1950- 2009) using selected keywords. Critical appraisal: by two trained reviewers, (a third review, if discrepant). Inclusion criteria: primary studies of inflicted spinal injury in children <18 years, alive at presentation, with a high surety of diagnosis of abuse and sufficient detail to analyse. RESULTS: 19 studies of 25 children were included. Twelve children, (median age 5 months) had cervical injury. In seven cases the clinical signs of spinal injury were masked by respiratory symptoms and impaired levels of consciousness, six of these children had co-existent inflicted head trauma. Twelve children with thoraco-lumbar injury (median age 13.5 months), 10/12 had lesions at T11-L2, 9/12 were fracture dislocations. All children had focal signs: 10/12 had lumbar kyphosis or thoraco-lumbar swelling, two had focal neurology. One child had cervical, thoracic and sacral injuries. CONCLUSIONS: Spinal injury is a potentially devastating inflicted injury in infants and young children. The published evidence-base is limited. However this case series leads us to recommend that any clinical or radiological indication of spinal injury warrant a MRI. In children undergoing brain MRI for abusive head trauma, consideration should be given to including a MRI of the spine. All skeletal surveys in children with suspected abuse should include lateral views of the cervical and thoraco-lumbar spine. Further prospective comparative studies would define the discriminating features of inflicted spinal injuries.<p /><p>Language: en</p>",
language="en",
issn="0003-9888",
doi="10.1136/adc.2009.169110",
url="http://dx.doi.org/10.1136/adc.2009.169110"
}