Fracture-dislocation of the lumbar spine in an abused child.

Abstract

* Abbreviation: SCIWORA = : spinal cord injury without observable radiographic abnormality Public awareness of child abuse has risen dramatically since Caffey's first description of an association between multiple fractures of the long bones, intraocular bleeding, and chronic subdural hematoma in six infants.1 Although fractures of the long bones, skull, and ribs attributable to child abuse have been well-described,2-12 few reports specifically address spinal injuries in cases of nonaccidental trauma.13-18 We report an unusual case of an isolated fracture-dislocation of the lumbar spine with a severe spinal injury as a presentation of child abuse. A 15-month-old white female was transferred to the duPont Hospital for Children (Wilmington, DE) for evaluation of lethargy, facial petechiae, a palpable upper lumbar prominence, and paraplegia. According to the mother, she had noted a “lump” on the child's lower back region approximately 1 week before admission. There was no history of trauma, and the child was otherwise asymptomatic. Evaluation by a covering pediatrician for this included anteroposterior and lateral spinal films at a local emergency room. These films reportedly showed no abnormality, and the child returned home. On the morning of admission, the mother reported that the child had awoken from sleep unable to move her legs. When seen at the transferring hospital, she was noted to be lethargic, with petechiae about the head and neck. She had a palpable prominence in the upper lumbar region and no evident motor or sensory function in the lower extremities. She was afebrile with stable vital signs. The findings were normal for the blood-cell count; coagulation tests; levels of serum glucose, creatinine, sodium chloride, potassium, and blood urea nitrogen. The serum liver function tests and alkaline phosphatase were slightly elevated. The serum amylase level was within normal limits. A computed tomography scan of the head was performed, which showed no abnormality. No additional radiographic studies were obtained. …