Lap-belt injuries of the lumbar spine in children: a pitfall in CT diagnosis.

A retrospective review of 365 consecutive CT studies in children assessed for intraabdominal trauma yielded five children in whom lap-belt-associated injuries of the lumbar spine were missed on CT. Facet subluxation and anterior dislocation of the third lumbar vertebra were present in four patients and multiple compression fractures were present in one. Clinical presentations included acute abdominal symptoms; two had acute back pain, and three experienced delayed onset of back pain. Although the injuries to the spine were visible retrospectively on anteroposterior radiographs, the findings were subtle and their extent was best appreciated on lateral lumbar spine views. Five of 365 patients with blunt abdominal trauma were identified as having sustained midlumbar spinal injury that was clearly visible only on a lateral radiograph of the spine.