Introduction

Spine injuries are uncommon but nonetheless important manifestations of child abuse. In infants and young children, spinal fractures have a strong association with abuse and their identification should raise the possibility of inflicted injury if an adequate history is not provided. The diagnosis of abusive spinal injury can be difficult for a number of reasons: (1) clinical assessment may be challenging based on the history provided by the caretaker – it may or may not be factual; (2) a history is usually not available from the victim since most abused children are preverbal, and those who are not may be neurologically compromised from associated head injury; (3) attention may be diverted elsewhere to more immediate and clinically apparent injuries; (4) physical examination may not reveal signs of spinal injury or neurologic deficits; and (5) initial imaging is frequently normal, particularly when cervical injuries are present. Thus, “silent” injuries can be missed unless appropriate imaging is performed. In addition, a clinically occult spinal fracture may be identified on cross-sectional imaging performed for other reasons.

Mild spinal injuries may go undiagnosed without adverse clinical result. Severe injuries can have catastrophic neurologic consequences (Fig. 21.1), and undiagnosed spinal injuries with ongoing instability can lead to persistent pain, repetitive cord injury, and spinal deformity.