A growing body of evidence links abusive head trauma (AHT) to patterns of direct spinal injury such as injury to the vertebral column, ligaments and soft tissues, and to indirect evidence of injury such as spinal subdural hemorrhage in the absence of obvious spinal injury [1, 2, 3]. The article by Dr. Rabbitt et al. [4] in the current issue of Pediatric Radiology reviews the topic comprehensively and adds to the literature on abusive head trauma. Multiple societies have recommended MR imaging of the entire spine in cases of AHT, including a recently published consensus statement on AHT supported by multiple societies [5]. But the practice of MR imaging of the spine in AHT varies across institutions, ranging from 4.3% to 84.3% [6]. The practice also varies regarding the extent of MR spinal imaging, from none, to cervical, to entire spine. The reasons for variability of spinal imaging include limited literature on the incidence of spinal findings in AHT, non-specificity of clinical signs predicting risk of spinal injury, logistical issues such as limited availability of sedation or MRI services, cost of imaging the entire spine, limited understanding of clinical and forensic markers identified on imaging, and the absence of spinal stability (which requires operative surgical management in most cases). The challenge of pathological confirmation of imaging findings, particularly of ligamentous injuries in the suboccipital region, can also be a contributory factor. These are real challenges, but so are the possible adverse outcomes ...
Language: en
LA - en SN - 0301-0449 UR - http://dx.doi.org/10.1007/s00247-019-04539-6 ID - ref1 ER -