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Characteristics of Spinal Injuries Secondary to Nonaccidental Trauma

Knox, Jeffrey MD*; Schneider, John MD; Wimberly, Robert L. MD; Riccio, Anthony I. MD

Journal of Pediatric Orthopaedics: June 2014 - Volume 34 - Issue 4 - p 376–381
doi: 10.1097/BPO.0000000000000111

Background: Nonaccidental trauma (NAT) is considered an uncommon cause of spine trauma in the pediatric population. Little has been published on such injuries and no large series is available in the literature. The purpose of this study is to describe the incidence and characteristics of spine trauma secondary to NAT.

Methods: An IRB-approved retrospective review of all patients presenting to a single level 1 pediatric trauma center with a spinal injury between 2003 and 2011 was performed. Patients were identified using our institution’s trauma registry. Medical records were reviewed to identify all spine injuries that occurred as a result of NAT. These cases were reviewed for details regarding injury mechanism, type and location of injury, associated injuries, and the treatment. Our institution’s NAT database was also queried to identify the total number of patients formally determined to have sustained any injury as a result of NAT during the same period.

Results: NAT was the cause of 11/342 (3.2%) spine injuries diagnosed during the study period. A total of 726 cases of NAT were identified, with spine injury present in 1.5%. All patients with spine trauma secondary to NAT were under the age of 2 years with an average age of 7 months. Among patients below 2 years with spinal trauma, NAT was tied as the most common mechanism, resulting in 38% of injuries. Eight of the 11 patients’ spine injuries were cervical and 7 of these injuries were in the atlanto-occipital and atlantoaxial regions. Multilevel spine trauma was present in 64% of patients. Associated head and thoracic trauma was present in 73% and 36% of patients, respectively. Neurological injury was found in 54% of patients. The majority of injuries were treated nonoperatively and 1 patient required surgical management.

Conclusions: NAT represents a very common yet often overlooked cause of spinal trauma in children under the age of 2 years. Because of its frequency in this age group, clinicians should consider including an assessment of the spine in all young NAT patients. Patients with spinal trauma sustained as a result of NAT must undergo a thorough evaluation for associated injuries remote to the spine, neurological deficit, and multilevel spine injury.

Summary: NAT is a common mechanism of spinal injury in patients below 2 years of age.

*Tripler Army Medical Center, Orthopedic Surgery Service, Honolulu, HI

Department of Pediatrics, University of Texas Southwestern Medical Center and Childrens Medical Center

Department of Orthopedics, Texas Scottish Rite Hospital for Children and Childrens Medical Center, Dallas, TX

The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

The authors declare no conflicts of interest.

Reprints: Anthony I. Riccio, MD, Department of Orthopedics, Texas Scottish Rite Hospital for Children and Childrens Medical Center, 1935 Medical District Drive, Dallas, TX 75235. E-mail:

© 2014 by Lippincott Williams & Wilkins