Spinal injuries in 57 patients 17 years or younger

Evaluation of traumatic spinal injuries: a pediatric perspective

PURPOSE

The aim of the present study is to provide information about pediatric patients with spinal trauma.

METHODS

A single-center retrospective chart review was carried out. Children who arrived at the pediatric emergency department due to trauma and those with spinal pathology confirmed by radiological assessment were included. Demographics, mechanisms of trauma, clinical findings, radiological investigations, applied treatments, hospital stay and prognosis were recorded.

RESULTS

A total of 105 patients [59 (56.2%) boys; mean age: 12.9 ± 3.8 years (mean ± SD)] were included. The most common age group was that of 14-18 years (58.1%). The three most common trauma mechanisms were road traffic collisions (RTCs) (60.0%), falls (32.4%), and diving into water (2.9%). A fracture of the spine was detected in 97.1% patients, vertebral dislocation in 10.7%, and spinal cord injury in 16.3%. Of the patients, 36.9% were admitted to the ward and 18.4% to the pediatric intensive care unit; 17.1% were discharged with severe complications and 2.9% cases resulted in death. While 34.3% of the patients had a clinically isolated spine injury, the remaining cases entailed an injury to at least one other body part; the most common associated injuries were to the head (39.8%), abdomen (36.1%), and external areas (28.0%).

CONCLUSION

Spinal trauma was found to have occurred mostly in adolescent males, and the majority of those cases were due to RTCs. Data on the incidence and demographic factors of pediatric spinal trauma are crucial in furthering preventive measures, allowing for the identification of at-risk populations and treatment modalities.

Pediatric Spinal Trauma at a Single Level 1 Trauma Center: Review of 62 Cases

Background

Traumatic spinal injuries in children are uncommon and result in different patterns of injuries due to the anatomical characteristics of children's spines. However, there are only a few epidemiological studies of traumatic spinal injury in children. The purpose of this study was to investigate the characteristics of traumatic spinal injury in children.

Methods

We retrospectively reviewed the cases of pediatric patients (age < 18 years) with traumatic spinal injury who were treated at a level 1 trauma center between January 2017 and December 2021. We divided them into three groups according to age and analyzed demographics, injury mechanism, level of injury, and injury pattern.

Results

A total of 62 patients (255 fractures) were included, and the mean age was 13.8 ± 3.2 years. There were 5 patients (22 fractures) in group I (0-9 years), 24 patients (82 fractures) in group II (10-14 years), and 33 patients (151 fractures) in group III (15-17 years). Both the Injury Severity Score and the Revised Trauma Score were highest in group I, but there was no statistical difference between the age groups. Fall from height was the most common injury mechanism, of which 63% were suicide attempts. The level of spinal injury was different in each age group, T10-L2 injury being the most common. In all age groups, the number of multilevel continuous injury was larger than that of single-level injury or multilevel noncontinuous injury. Surgical intervention was required in 33.9%, and mortality was 3.2%.

Conclusions

In our study, fall from height was the most common mechanism of injury, and there were many suicide attempts associated with mental health issues. Thoracolumbar junction injuries were predominant, and the rate of multilevel contiguous injuries was high. The support and interest of the society and families for adolescent children seem crucial in preventing spinal trauma, and image testing of the entire spine is essential when evaluating pediatric spinal injuries.

Fractures of the Bilateral C2 Neurocentral and Lateral Dental Synchondroses with Kyphotic C1-C2 Subluxation in a 3-Year-Old Girl: A Description of a Rare Fracture Pattern and Its Treatment: A Case Report

CASE

Spinal fractures are rare in young children. Because spinal anatomy and biomechanics differ in children and adults, knowledge of the deviations of the juvenile spine is necessary for adequate treatment. We present the case of a young girl with an unusual C2 fracture that included rupture of both of the neurocentral and lateral dental synchondroses, with an opening of the synchondroses and a caudal dislocation of both vertebral arches following a head-on motor vehicle collision. The whole body and apex of the dens was displaced anteriorly and cranially with a kyphotic angulation of 34°. We describe the treatment and clinical and radiographic outcome after 1 year.

CONCLUSION

Using passive hyperextension and distraction of the head, a closed open-mouth digital reduction was performed under continuous fluoroscopy. At the 1-year follow-up, the patient had full range of motion of the head without pain or neurologic dysfunction.

Classification and Management of Pediatric Subaxial Cervical Spine Injuries

Appropriate management of subaxial spine injury in children requires an appreciation for the differences in anatomy, biomechanics, injury patterns, and treatment options compared with adult patients. Increased flexibility, weak neck muscles, and cranial disproportion predispose younger children to upper cervical injuries and spinal cord injury without radiographic abnormality. A majority of subaxial cervical spine injuries can be treated nonoperatively. Surgical instrumentation options for children have significantly increased in recent years. Future studies of outcomes for children with subaxial cervical spine injury should focus on injury classification and standardized outcome measures to ensure continued improvement in quality of care for this patient population.

Lumbar vertebral fractures in children: four cases and review of the literature

BACKGROUND

Vertebral fractures and severe injuries to the spine cord in children are rare and account for a small proportion of all childhood injuries. Pediatric vertebral and spinal cord injuries have unique characteristics depending on their age. Young children sustain upper cervical spine injuries, which are more serious injuries and have a higher mortality rate. Older children have lower spine injuries and thoracoabdominal injuries.

OBJECTIVES

This study aimed to present the epidemiology and potential complications from lumbar spine fractures.

CASES

There were 4 cases of older children who sustained lumbar vertebral fractures.

CONCLUSIONS

Fractures of the lumbar spine in children, although relatively rare, are important to understand. Patterns of injury with vertebral and spinal cord injuries in children vary from those of adults. The biologic differences of children make differences in fracture patterns and alter the management necessary for successful treatment. Errors in management can have adverse effects on these injuries.

Cervical spine trauma in children: a review

Injuries of the cervical spine are relatively rare in children but are a distinct clinical entity compared with those found in adults. The unique biomechanics of the pediatric cervical spine lead to a different distribution of injuries and distinct radiographic features. Children younger than 9 years of age usually have upper cervical injuries, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. Pediatric cervical injuries are more frequently ligamentous in nature, and children are also more prone to spinal cord injury without radiographic abnormality than adults are. Physical injuries are specific only to children. Radiographically benign findings, such as pseudosubluxation and synchondrosis, can be mistaken for traumatic injuries. External immobilization with a halo brace can be difficult and is associated with a high complication rate because of the thin calvaria in children. Surgical options have improved with the development of instrumentation specifically for children, but special considerations exist, such as the small size and growth potential of the pediatric spine.

Pediatric spinal cord injury without radiographic abnormality: a meta-analysis

Using a meta-analysis, we identified 392 published cases of patients recently diagnosed with spinal cord injuries without radiographic abnormalities (SCIWORA) and studied the epidemiologic, pathophysiologic, clinical, and radiologic data. To describe those at risk for this uncommon syndrome, mainly pediatric patients (90% of the cases) who sustain serious trauma in car accidents, serious falls, sports injuries, or child abuse, we analyzed the reported information in the literature. Magnetic resonance imaging scans may indicate neural (hemorrhages, edema, or both) or extraneural (disc protrusions, extradural hematomas) injuries, and the location and type of the injury. Every patient having magnetic resonance imaging scans had either intraneural or extraneural injury. However, followup magnetic resonance imaging scans are necessary because evidence of the injury might not appear immediately. Late and recurrent spinal cord injuries without radiographic abnormalities are reported. External immobilization for 12 weeks helps patients who are moderately injured and helps prevent recurrence of these types of injuries. Approximately 44% of the patients in our study did not recover whereas complete recovery occurred in 39% of the population. The prognosis can be improved if the syndrome is diagnosed early, so we recommend considering spinal cord injuries without radiographic abnormalities as a possible diagnosis for any child who has a mechanism of injury that suggests trauma to the spine.

LEVEL OF EVIDENCE

Therapeutic study, Level III-3 (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.

Severe fracture-dislocation of S1 in a 12-year-old boy. A case report

STUDY DESIGN

This study analyzes an unusual case of severe fracture-dislocation of S1 in a child.

OBJECTIVES

To provide a better understanding of a rare pediatric sacral injury based on a successfully treated patient.

SUMMARY OF BACKGROUND DATA

Literature on sacral fractures in children is limited to a few case reports.

METHODS

A 12-year-old boy who had severe fracture-dislocation of S1 with progressing neurologic deficits underwent closed reduction under general anesthesia followed by skeletal traction for 60 days.

RESULTS

Closed reduction allowed a satisfactory, although not complete, restoration of the sagittal alignment at the lumbosacral junction. Some loss of reduction occurred before fracture healing but had no influence on the clinical outcome. Motor deficits recovered, whereas bladder and bowel dysfunction persisted 13 months after injury.

CONCLUSIONS

The choice of a conservative approach may be a successful alternative in the management of sacral fracture-dislocations in children.