The spine in paediatric non-accidental head injury

Abstract

The diagnostic triad of retinal haemorrhages, multicompartmental cranial subdural bleeds and hypoxic-ischaemic brain injury remains contentious as sufficient proof of paediatric non-accidental head injury. Examination of the paediatric spine in such cases has further contributed to the spectrum of supportive pathology in this regard. Imaging including micro-CT and MRI STIR have identified osteo-articular lesional pathology supportive of traumatic injury of vertebral bone and ligamentous structures and the recognition of a strong association between non-accidental head injury and spinal subdural haemorrhage has added substantially to the spectrum of neuropathology relied upon to inform a diagnosis of NAHI. It appears that the source of spinal subdural haemorrhage may either involve tracking down of subdural blood from an intracranial source or it might involve a local source due to spinal trauma, e.g., traumatic bleeds associated with spinal nerve roots. Axonal injury identified within spinal cord white matter tracts and within spinal nerve roots could potentially also represent traumatic pathology but such features and spinal nerve root and ganglion-related bleeds could, in the author’s opinion, also in certain circumstances be related to secondary hypoxic-ischaemic tissue injury, warranting greater caution as to its diagnostic reliability to confirm spinal trauma.