Review Article
Pediatric Thoracolumbar Spine Trauma Abstract Alan H. Daniels, MD Andrew D. Sobel, MD Craig P. Eberson, MD
From the Warren Alpert Medical School, Brown University, Providence, RI. Dr. Daniels or an immediate family member has received research or institutional support from Synthes and Flexuspine. Dr. Eberson or an immediate family member has received royalties from Globus Medical, is a member of a speakers’ bureau or has made paid presentations on behalf of Stryker Spine and Orthofix, and serves as a paid consultant to Orthofix. Neither Dr. Sobel nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article. J Am Acad Orthop Surg 2013;21: 707-716 http://dx.doi.org/10.5435/ JAAOS-21-12-707 Copyright 2013 by the American Academy of Orthopaedic Surgeons.
December 2013, Vol 21, No 12
Thoracolumbar spine trauma is an important cause of morbidity and mortality in pediatric patients. Special attention to this population is necessary because several unique features of the growing pediatric spine separate these patients from adult patients. These injuries are frequently associated with high-energy trauma and concurrent thoracic or abdominal injuries that require coordinated multidisciplinary care. Thoracolumbar spine trauma in pediatric patients may lead to compression fractures, burst fractures, flexion-distraction injuries (ie, Chance fracture), fracturedislocation injuries, apophyseal fractures/herniations, and spinous process and transverse process fractures. Depending on the nature of the injury and the patient’s level of skeletal maturity, thoracolumbar spinal injuries may have substantial ability to heal and remodel. Because the impact of thoracolumbar spinal injury on pediatric patients can be devastating, appropriate early diagnosis and management, as well as long-term follow-up, are imperative.
T
raumatic thoracolumbar spine injuries are rare but potentially lifechanging injuries in pediatric and adolescent patients and carry many unique considerations for diagnosis and management. The range of thoracolumbar spinal injuries in pediatric patients varies from commonly encountered minor compression fractures to rarely encountered fracturedislocations with associated complete spinal cord injury. Given the wide array of injury patterns to the thoracolumbar spine, appropriate treatment must be based on a firm understanding of the pediatric spinal anatomy, biomechanics, healing and growth potential, and biopsychosocial factors in young patients. Careful follow-up of thoracolumbar fractures is important because of the remaining growth potential of the spine and the risk of late deformity, instability, and neurologic injury.
Epidemiology Spine injuries in children are far less common than in adults, accounting for 2% to 5% of all spine trauma.1-3 Five percent of all pediatric fractures occur in the spine; fractures of the thoracolumbar spine account for 1% to 2% of all pediatric fractures.2-4 The most common cause of thoracolumbar pediatric spine trauma is motor vehicle accidents, which lead to 33% to 58% of all injuries.3,5,6 Other frequent mechanisms of thoracolumbar spine trauma include falls from a height, sport-related injuries, and child abuse.3,6,7 Football, rugby, and skiing are associated with a high risk of thoracolumbar spine injury; sledding and all-terrain vehicle (ATV) use are also cited as high-risk activities for thoracolumbar spine injury.8-10 Children aged 3 years, seat belt and child safety seat policies have been issued by the American Academy of Pediatrics.12 The recommendations are the use of (1) rear-facing car safety seats for infants up to 2 years of age, (2) forward-facing car safety seats for children through 4 years of age, (3) belt-positioning booster seats for children through 8 years of age, and (4) lap-and-shoulder seat belts for all who have outgrown booster seats, as well as (5) the requirement that all children aged
Pediatric Thoracolumbar Spine Trauma Abstract Alan H. Daniels, MD Andrew D. Sobel, MD Craig P. Eberson, MD
From the Warren Alpert Medical School, Brown University, Providence, RI. Dr. Daniels or an immediate family member has received research or institutional support from Synthes and Flexuspine. Dr. Eberson or an immediate family member has received royalties from Globus Medical, is a member of a speakers’ bureau or has made paid presentations on behalf of Stryker Spine and Orthofix, and serves as a paid consultant to Orthofix. Neither Dr. Sobel nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article. J Am Acad Orthop Surg 2013;21: 707-716 http://dx.doi.org/10.5435/ JAAOS-21-12-707 Copyright 2013 by the American Academy of Orthopaedic Surgeons.
December 2013, Vol 21, No 12
Thoracolumbar spine trauma is an important cause of morbidity and mortality in pediatric patients. Special attention to this population is necessary because several unique features of the growing pediatric spine separate these patients from adult patients. These injuries are frequently associated with high-energy trauma and concurrent thoracic or abdominal injuries that require coordinated multidisciplinary care. Thoracolumbar spine trauma in pediatric patients may lead to compression fractures, burst fractures, flexion-distraction injuries (ie, Chance fracture), fracturedislocation injuries, apophyseal fractures/herniations, and spinous process and transverse process fractures. Depending on the nature of the injury and the patient’s level of skeletal maturity, thoracolumbar spinal injuries may have substantial ability to heal and remodel. Because the impact of thoracolumbar spinal injury on pediatric patients can be devastating, appropriate early diagnosis and management, as well as long-term follow-up, are imperative.
T
raumatic thoracolumbar spine injuries are rare but potentially lifechanging injuries in pediatric and adolescent patients and carry many unique considerations for diagnosis and management. The range of thoracolumbar spinal injuries in pediatric patients varies from commonly encountered minor compression fractures to rarely encountered fracturedislocations with associated complete spinal cord injury. Given the wide array of injury patterns to the thoracolumbar spine, appropriate treatment must be based on a firm understanding of the pediatric spinal anatomy, biomechanics, healing and growth potential, and biopsychosocial factors in young patients. Careful follow-up of thoracolumbar fractures is important because of the remaining growth potential of the spine and the risk of late deformity, instability, and neurologic injury.
Epidemiology Spine injuries in children are far less common than in adults, accounting for 2% to 5% of all spine trauma.1-3 Five percent of all pediatric fractures occur in the spine; fractures of the thoracolumbar spine account for 1% to 2% of all pediatric fractures.2-4 The most common cause of thoracolumbar pediatric spine trauma is motor vehicle accidents, which lead to 33% to 58% of all injuries.3,5,6 Other frequent mechanisms of thoracolumbar spine trauma include falls from a height, sport-related injuries, and child abuse.3,6,7 Football, rugby, and skiing are associated with a high risk of thoracolumbar spine injury; sledding and all-terrain vehicle (ATV) use are also cited as high-risk activities for thoracolumbar spine injury.8-10 Children aged 3 years, seat belt and child safety seat policies have been issued by the American Academy of Pediatrics.12 The recommendations are the use of (1) rear-facing car safety seats for infants up to 2 years of age, (2) forward-facing car safety seats for children through 4 years of age, (3) belt-positioning booster seats for children through 8 years of age, and (4) lap-and-shoulder seat belts for all who have outgrown booster seats, as well as (5) the requirement that all children aged
