Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases

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Object

The authors evaluated the mechanisms and patterns of thoracic, lumbar, and sacral spinal injuries in a pediatric population as well as factors affecting the management and outcome of these injuries.

Methods

The records of 89 patients (46 boys and 43 girls; mean age 13.2 years, range 3–16 years) with thoracic, lumbar, or sacral injuries were reviewed. Motor vehicle accidents were the most common cause of injury. Eighty-two patients (92.1%) were between 10 and 16 years old, and seven (7.9%) were between 3 and 9 years old. Patient injuries included fracture (91%), fracture and dislocation (6.7%), dislocation (1.1%), and ligamentous injury (1.1%). The L2–5 region was the most common injury site (29.8%) and the sacrum the least common injury site (5%). At the time of presentation 85.4% of the patients were neurologically intact, 4.5% had incomplete injuries, and 10.1% had complete injuries. Twenty-six percent of patients underwent surgery for their injuries whereas 76% received nonsurgical treatment. In patients treated surgically, an anterior approach was used in six patients (6.7%), a posterior approach in 16 (18%), and a combined approach in one (1.1%). Postoperatively, six patients (26.1%) with neurological deficits improved, one of whom recovered fully from an initially complete injury.

Conclusions

Thoracic and lumbar spine injuries were most common in children older than 9 years. Multilevel injuries were common and warranted imaging evaluation of the entire spinal column. Most patients were treated conservatively. The prognosis for neurological recovery is related to the initial severity of the neurological injuries. Some pediatric patients with devastating spinal cord injuries can recover substantial neurological function.

Abbreviations used in this paper:ASIA = American Spinal Injury Association; CT = computed tomography; MR = magnetic resonance; MVA = motor vehicle accident; SCI = spinal cord injury; TLSO = thoracolumbosacral orthosis; VB = vertebral body.

Article Information

Address reprint requests to: Nicholas Theodore, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@chw.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 3. Preoperative (left) and postoperative (right) sagittal CT scans obtained in a 9-year-old patient with an L-1 burst fracture (arrow in left). The patient underwent an L-1 corpectomy and T12–L2 stabilization (right).

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    Case 1. Preoperative sagittal MR image (A) and CT scan (B), and postoperative sagittal (C) and axial (D) CT scans obtained in a 4-year-old patient with a severe T11–12 dislocation (A) and a fracture of the anterior portion of the T-12 VB (arrow in A). The postoperative images show T-10 to L-1 pedicle screw fixation and fusion (C and D).

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