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Spinal lesions caused by abusive trauma in young children

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Abstract

Background and purpose

Spinal lesions are increasingly recognized as an integral part of the child abuse spectrum; however, the description of lesions, their biomechanics, true incidence, clinical impact, and medicolegal implications are poorly understood.

Material and methods

We report from the literature and our personal experience on abusive spinal lesions (ASL) in children under 3 years, compared with cases of abusive head injuries (AHI) without spinal lesions on the one hand and with accidental spinal lesions on the other.

Results

Between 2002 and 2021, we collected 12 observations of ASL, 4 male and 8 female. These were compared with 338 cases of infants having AHI without ASL and 18 cases of accidental spinal trauma in the same age group. Fractures were found in 10 cases of ASL: wedge fracture in 9, and complete disruption with paraplegia in one, which required emergency reduction and stabilization with a good motor recovery. Two patients had intraspinal hemorrhagic lesions without fracture, associated in one case with tetraplegia which contributed to the fatal outcome. ASL affected girls more often and had a more severe clinical presentation; more than half of ASL involved the lumbar levels, which were unaffected in accidental traumas.

Conclusions

ASL are not exceptional, and their presence corroborates cranial lesions indicating child abuse. Two etiologies emerge from this study: wedge fractures and cervical spinal cord lesions caused by shaking and the rare thoraco-lumbar dislocation indicating a particularly violent assault. Systematic MRI study of the spine is warranted in cases of child abuse.

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Data availability

We the authors commit ourselves to provide all data upon request.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Lille University Hospital, Lille, France

    Amélie Toubol & Mélodie-Anne Karnoub

  2. Department of Pediatric Neurosurgery, Hospices Civils de Lyon, Lyon, France

    Matthieu Vinchon

  3. Unité Médico-Judiciaire, Arras General Hospital, Arras, France

    Nathalie Noulé

Authors
  1. Matthieu Vinchon
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  2. Nathalie Noulé
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  3. Amélie Toubol
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  4. Mélodie-Anne Karnoub
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Contributions

Dr. Nathalie Noulé collected the legal data. Pr Matthieu Vinchon collected the clinical data and wrote the draft of the paper. Dr. Mélodie-Anne Karnoub and Amélie Toubol revised the manuscript.

Corresponding author

Correspondence to Matthieu Vinchon.

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Ethics approval and consent to participate

This study has received ethical clearance IRB approval no. IRB00011687 by the French Collège de Neurochirurgie IRB #1 2022/19; consent to participate is not applicable for a retrospective study.

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Vinchon, M., Noulé, N., Toubol, A. et al. Spinal lesions caused by abusive trauma in young children. Childs Nerv Syst 38, 2349–2355 (2022). https://doi.org/10.1007/s00381-022-05778-z

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