CHILD-ABUSE PRESENTING AS A THORACOLUMBAR SPINAL FRACTURE-DISLOCATION- A CASE-REPORT

A child sustained a traumatic thoracolumbar spinal fracture-dislocatio n with cord compression. A court confirmed the diagnosis of child abus e. There was no history of trauma, and the diagnosis of child abuse wa s missed by the physicians who first saw the child. Spinal injuries in child abuse are uncommon. They may be symptomatic or asymptomatic, st able or unstable, or occur with or without bony changes on the x-rays. Injuries without a history of trauma may be overlooked if asymptomati c. Radiologic skeletal surveys in suspected abuse should include a min imum of two views of the spine even if the child has no symptoms refer rable to the spine. Conversely, a traumatic cause should be considered whenever there is spinal cord injury without vertebral injury. Having a high index of suspicion for abuse while remembering that pediatric spinal injuries may occur in the context of normal x-rays will decreas e the likelihood of missed diagnosis, repeated abuse, or complications from delayed immobilization of unstable injuries.