Pediatric abusive spine trauma: a review of whole-spine imaging essentials

Abusive spinal injuries, although often clinically silent, may require treatment and have medicolegal significance. Abused infants are prone to ligamentous injury of the craniocervical junction and upper cervical spine, which is often associated with brain hypoxic-ischemic injury. Although they are relatively common and highly specific for abuse, thoracolumbar spine injuries (e.g., thoracolumbar compression fractures and spinal extra-axial hemorrhages) are most often clinically occult. Additionally, they are often undetectable on skeletal survey and are frequently found in the absence of cervical spine injuries. Therefore, MRI screening of the whole spine is needed in selected cases of abusive trauma with potential for spinal injuries. This review discusses indications and summarizes recommendations for whole-spine imaging in cases of suspected child abuse. Imaging examples that emphasize the importance of whole-spine MRI in child abuse are provided. Vertebral fracture, spinal cord injury, spinal hemorrhage, and ligamentous and paraspinal soft tissue injury are discussed and illustrated.