Non-accidental Trauma to the Thoracolumbar Spine in a 10-month-old Child
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Published:
Dec 20, 2023
Keywords:
Children, non-accidental trauma, thoracolumbar spine
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Abstract
We present the case of a 10-month-old boy with a chronic thoracolumbar spine fracture-subluxation without neurological damage caused by an unknown mechanism of non-accidental trauma. To assess stability, we used the scoring system for thoracolumbar injuries according to Vaccaro et al. We performed a segmental pedicle osteosynthesis. We analyzed and compared our case with others in the available literature. We updated UNICEF data on child violence in Argentina, but not before clearly defining the subject, and the legal framework, and providing a brief historical review.
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How to Cite
Fernández, C. A., Moreiro, M. E., Miranda, M. G., & Romano Yalour, N. (2023). Non-accidental Trauma to the Thoracolumbar Spine in a 10-month-old Child. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(6), 681-688. https://doi.org/10.15417/issn.1852-7434.2023.88.6.1767
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Case Presentations
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References
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3. Pinto Cortez C. Perspectiva histórica en el estudio del maltrato infantil. Poiésis 2009;9(17). Disponible en: https://revistas.ucatolicaluisamigo.edu.co/index.php/poiesis/article/view/166 [Consulta: 29 de marzo, 2023]
4. UNICEF y Ministerio de Justicia y Derechos Humanos, Argentina. Serie Violencia contra Niñas, Niños y
Adolescentes. Fascículo N.° 9. Un análisis de los datos del Programa “Las Víctimas Contra las Violencias” 2020-2021. Disponible en: https://www.unicef.org/argentina/informes/serie-violencia-contra-ninas-ninos-y-adolescentes# [Consulta: 23 de marzo, 2023]
5. Sánchez NI, Cuenya L. Estudio sobre maltrato infantil en niños y adolescentes de la Provincia de Buenos Aires. Revista Argentina de Ciencias del Comportamiento 2011;3(3):8-15. https://doi.org/10.32348/1852.4206.v3.n3.5200
6. Thornley P, Peterson D, Kishta W. Child abuse with thoracolumbar fracture-dislocation treated with pedicle screw fixation in a 2-year-old: A case report. JBJS Case Connect 2021;11(4). https://doi.org/10.2106/JBJS.CC.21.00129
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characteristics of spinal injuries from physical abuse: a systematic review. Arch Dis Child 2010;95(5):355-60. https://doi.org/10.1136/adc.2009.169110
9. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of
thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 2005;30(20):2325-33. https://doi.org/10.1097/01.brs.0000182986. 43345.cb
10. Daniels AH, Sobel AD, Eberson CP. Pediatric thoracolumbar spine trauma. J Am Acad Orthop Surg 2013;21(12):707-16. https://doi.org/10.5435/JAAOS-21-12-707
11. Savage JW, Moore TA, Arnold PM, Thakur N, Hsu WK, Patel AA, et al. The reliability and validity of the
Thoracolumbar Injury Classification System in Pediatric Spine Trauma. Spine (Phila Pa 1976) 2015;40(18):
E1014-8. https://doi.org/10.1097/BRS.0000000000001011
12. Kleinman PK, Marks SC. Vertebral body fractures in child abuse. Radiologic-histopathologic correlates. Invest Radiol 1992;27(9):715-22. https://doi.org/10.1097/00004424-199209000-00013
13. Aufdermaur M. Spinal injuries in juveniles. Necropsy findings in twelve cases. J Bone Joint Surg Br
1974;56(3):513-9. PMID: 4417629
14. Carroll T, Smith CD, Liu X, Bonaventura B, Mann N, Liu J, et al. Spinal cord injuries without radiologic
abnormality in children: a systematic review. Spinal Cord 2015;53(12):842-8. https://doi.org/10.1038/sc.2015.110
15. Leroux J, Vivier PH, Ould Slimane M, Foulongne E, Abu-Amara S, Lechevallier J, et al. Early diagnosis of
thoracolumbar spine fractures in children. A prospective study. Orthop Traumatol Surg Res 2013;99(1):60-5. https://doi.org/10.1016/j.otsr.2012.10.009
16. Mitchell LA, Kitley CA, Armitage TL, Krasnokutsky MV, Rooks VJ. Normal sagittal and coronal suture widths by using CT imaging. AJNR Am J Neuroradiol 2011;32(10):1801-5. https://doi.org/10.3174/ajnr. A2673
17. Sieradzki JP, Sarwark JF. Thoracolumbar fracture-dislocation in child abuse: case report, closed reduction technique and review of the literature. Pediatr Neurosurg 2008;44(3):253-7. https://doi.org/10.1159/000121475
18. Arkader A, Warner WC Jr, Tolo VT, Sponseller PD, Skaggs DL. Pediatric chance fractures: a multicenter
perspective. J Pediatr Orthop 2011;31(7):741-4. https://doi.org/10.1097/BPO.0b013e31822f1b0b
19. Bode KS, Newton PO. Pediatric nonaccidental trauma thoracolumbar fracture-dislocation: posterior spinal fusion with pedicle screw fixation in an 8-month-old boy. Spine (Phila Pa 1976) 2007;32(14): E388-93. https://doi.org/10.1097/BRS.0b013e318067dcad
20. Zindrick MR, Knight GW, Sartori MJ, Carnevale TJ, Patwardhan AG, Lorenz MA. Pedicle morphology of the immature thoracolumbar spine. Spine (Phila Pa 1976) 2000;25(21):2726-35. https://doi.org/10.1097/00007632-200011010-00003
21. Ruf M, Harms J. Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth. Spine (Phila Pa 1976) 2002;27(21):E460-6. https://doi.org/10.1097/00007632-200211010-00019
22. Olgun ZD, Demirkiran G, Ayvaz M, Karadeniz E, Yazici M. The effect of pedicle screw insertion at a young age on pedicle and canal development. Spine (Phila Pa 1976) 2012;37(20):1778-84. https://doi.org/10.1097/BRS.0b013e3182553ae0
23. Kahraman S, Karadereler S, Cobanoglu M, Yilar S, Mutlu A, Ulusoy LO, et al. Does pedicle screw fixation under age 5 cause spinal canal narrowing? A CT study with minimum 5 years follow-up. Eur Spine J 2016;25(6):1665-73. https://doi.org/10.1007/s00586-016-4484-6
24. Wang X, Zhang SJ, Zhang YZ, Li XH, Zhang ZF, et al. Three-dimensional digitizing and anatomic study of lumbar vertebral canal and pedicle in children. Wideochir Inne Tech Maloinwazyjne 2018;13(4):518-24.
https://doi.org/10.5114/wiitm.2018.77554
25. Hinck VC, Clark WM Jr, Hopkins CE. Normal interpediculate distances (minimum and maximum) in children and adults. Am J Roentgenol Radium Ther Nucl Med 1966;97(1):141-53. https://doi.org/10.2214/ajr.97.1.141
2. Romano Yalour N, Fernández C. Maltrato infantil. En: Romano O, Fernández C (coord.). Lo esencial en Ortopedia y Traumatología. La Plata: EDULP; 2023, cap. 22 [En prensa]
3. Pinto Cortez C. Perspectiva histórica en el estudio del maltrato infantil. Poiésis 2009;9(17). Disponible en: https://revistas.ucatolicaluisamigo.edu.co/index.php/poiesis/article/view/166 [Consulta: 29 de marzo, 2023]
4. UNICEF y Ministerio de Justicia y Derechos Humanos, Argentina. Serie Violencia contra Niñas, Niños y
Adolescentes. Fascículo N.° 9. Un análisis de los datos del Programa “Las Víctimas Contra las Violencias” 2020-2021. Disponible en: https://www.unicef.org/argentina/informes/serie-violencia-contra-ninas-ninos-y-adolescentes# [Consulta: 23 de marzo, 2023]
5. Sánchez NI, Cuenya L. Estudio sobre maltrato infantil en niños y adolescentes de la Provincia de Buenos Aires. Revista Argentina de Ciencias del Comportamiento 2011;3(3):8-15. https://doi.org/10.32348/1852.4206.v3.n3.5200
6. Thornley P, Peterson D, Kishta W. Child abuse with thoracolumbar fracture-dislocation treated with pedicle screw fixation in a 2-year-old: A case report. JBJS Case Connect 2021;11(4). https://doi.org/10.2106/JBJS.CC.21.00129
7. Jauregui JJ, Perfetti DC, Cautela FS, Frumberg DB, Naziri Q, Paulino CB. Spine injuries in child abuse. J Pediatr Orthop 2019;39(2):85-9. https://doi.org/10.1097/BPO.0000000000000877
8. Kemp AM, Joshi AH, Mann M, Tempest V, Liu A, Holden S, et al. What are the clinical and radiological
characteristics of spinal injuries from physical abuse: a systematic review. Arch Dis Child 2010;95(5):355-60. https://doi.org/10.1136/adc.2009.169110
9. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of
thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 2005;30(20):2325-33. https://doi.org/10.1097/01.brs.0000182986. 43345.cb
10. Daniels AH, Sobel AD, Eberson CP. Pediatric thoracolumbar spine trauma. J Am Acad Orthop Surg 2013;21(12):707-16. https://doi.org/10.5435/JAAOS-21-12-707
11. Savage JW, Moore TA, Arnold PM, Thakur N, Hsu WK, Patel AA, et al. The reliability and validity of the
Thoracolumbar Injury Classification System in Pediatric Spine Trauma. Spine (Phila Pa 1976) 2015;40(18):
E1014-8. https://doi.org/10.1097/BRS.0000000000001011
12. Kleinman PK, Marks SC. Vertebral body fractures in child abuse. Radiologic-histopathologic correlates. Invest Radiol 1992;27(9):715-22. https://doi.org/10.1097/00004424-199209000-00013
13. Aufdermaur M. Spinal injuries in juveniles. Necropsy findings in twelve cases. J Bone Joint Surg Br
1974;56(3):513-9. PMID: 4417629
14. Carroll T, Smith CD, Liu X, Bonaventura B, Mann N, Liu J, et al. Spinal cord injuries without radiologic
abnormality in children: a systematic review. Spinal Cord 2015;53(12):842-8. https://doi.org/10.1038/sc.2015.110
15. Leroux J, Vivier PH, Ould Slimane M, Foulongne E, Abu-Amara S, Lechevallier J, et al. Early diagnosis of
thoracolumbar spine fractures in children. A prospective study. Orthop Traumatol Surg Res 2013;99(1):60-5. https://doi.org/10.1016/j.otsr.2012.10.009
16. Mitchell LA, Kitley CA, Armitage TL, Krasnokutsky MV, Rooks VJ. Normal sagittal and coronal suture widths by using CT imaging. AJNR Am J Neuroradiol 2011;32(10):1801-5. https://doi.org/10.3174/ajnr. A2673
17. Sieradzki JP, Sarwark JF. Thoracolumbar fracture-dislocation in child abuse: case report, closed reduction technique and review of the literature. Pediatr Neurosurg 2008;44(3):253-7. https://doi.org/10.1159/000121475
18. Arkader A, Warner WC Jr, Tolo VT, Sponseller PD, Skaggs DL. Pediatric chance fractures: a multicenter
perspective. J Pediatr Orthop 2011;31(7):741-4. https://doi.org/10.1097/BPO.0b013e31822f1b0b
19. Bode KS, Newton PO. Pediatric nonaccidental trauma thoracolumbar fracture-dislocation: posterior spinal fusion with pedicle screw fixation in an 8-month-old boy. Spine (Phila Pa 1976) 2007;32(14): E388-93. https://doi.org/10.1097/BRS.0b013e318067dcad
20. Zindrick MR, Knight GW, Sartori MJ, Carnevale TJ, Patwardhan AG, Lorenz MA. Pedicle morphology of the immature thoracolumbar spine. Spine (Phila Pa 1976) 2000;25(21):2726-35. https://doi.org/10.1097/00007632-200011010-00003
21. Ruf M, Harms J. Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth. Spine (Phila Pa 1976) 2002;27(21):E460-6. https://doi.org/10.1097/00007632-200211010-00019
22. Olgun ZD, Demirkiran G, Ayvaz M, Karadeniz E, Yazici M. The effect of pedicle screw insertion at a young age on pedicle and canal development. Spine (Phila Pa 1976) 2012;37(20):1778-84. https://doi.org/10.1097/BRS.0b013e3182553ae0
23. Kahraman S, Karadereler S, Cobanoglu M, Yilar S, Mutlu A, Ulusoy LO, et al. Does pedicle screw fixation under age 5 cause spinal canal narrowing? A CT study with minimum 5 years follow-up. Eur Spine J 2016;25(6):1665-73. https://doi.org/10.1007/s00586-016-4484-6
24. Wang X, Zhang SJ, Zhang YZ, Li XH, Zhang ZF, et al. Three-dimensional digitizing and anatomic study of lumbar vertebral canal and pedicle in children. Wideochir Inne Tech Maloinwazyjne 2018;13(4):518-24.
https://doi.org/10.5114/wiitm.2018.77554
25. Hinck VC, Clark WM Jr, Hopkins CE. Normal interpediculate distances (minimum and maximum) in children and adults. Am J Roentgenol Radium Ther Nucl Med 1966;97(1):141-53. https://doi.org/10.2214/ajr.97.1.141