PURPOSE: Spinal injuries are rarely seen in pediatric patients and therapeutic options are still poorly defined. The present study is aimed to present our experience with a rather large series of children and young adults suffering from traumatic spinal injury. PATIENTS AND METHODS: Between 1990 and 2010, 75 consecutive pediatric patients with spinal injuries were treated in our institution. Mean age was 15 years, ranging from 3 months to 21 years. Radiological findings, treatment strategies, and clinical outcome were evaluated retrospectively and compared with literature. Forty (53.3%) patients were treated conservatively and 35 patients (47%) surgically using anterior or posterior approaches. Subgroup analysis was performed depending on age groups, severity of neurological symptoms, and localization. RESULTS: Main trauma mechanisms were fall in 24 patients (38%) and motor vehicle accidents in 21 patients (28%). Complete neurological deficits were present in 17 individuals (23%) and incomplete in 36 patients (48%). Fractures were most frequently localized at the cervical region (56%) with predilection of the C 5/6 segment. Odontoid fractures were seen in 10 (13%) patients. Fractures of the lumbar and thoracic region were rare. Level of injury or clinical course did not differ between the subgroups (≤15 years versus >15 years). CONCLUSION: Nearly three fourths of all radiologically detected spinal injuries are located at the cervical spine. Complete neurological deficits after trauma was associated with a poor outcome, in particular for patients with injuries of the upper cervical spine. The use of autologous bone graft was associated with favorable long-term results and should be considered as the material of first choice for vertebral body and disc replacement.
PURPOSE:Spinal injuries are rarely seen in pediatric patients and therapeutic options are still poorly defined. The present study is aimed to present our experience with a rather large series of children and young adults suffering from traumatic spinal injury. PATIENTS AND METHODS: Between 1990 and 2010, 75 consecutive pediatric patients with spinal injuries were treated in our institution. Mean age was 15 years, ranging from 3 months to 21 years. Radiological findings, treatment strategies, and clinical outcome were evaluated retrospectively and compared with literature. Forty (53.3%) patients were treated conservatively and 35 patients (47%) surgically using anterior or posterior approaches. Subgroup analysis was performed depending on age groups, severity of neurological symptoms, and localization. RESULTS: Main trauma mechanisms were fall in 24 patients (38%) and motor vehicle accidents in 21 patients (28%). Complete neurological deficits were present in 17 individuals (23%) and incomplete in 36 patients (48%). Fractures were most frequently localized at the cervical region (56%) with predilection of the C 5/6 segment. Odontoid fractures were seen in 10 (13%) patients. Fractures of the lumbar and thoracic region were rare. Level of injury or clinical course did not differ between the subgroups (≤15 years versus >15 years). CONCLUSION: Nearly three fourths of all radiologically detected spinal injuries are located at the cervical spine. Complete neurological deficits after trauma was associated with a poor outcome, in particular for patients with injuries of the upper cervical spine. The use of autologous bone graft was associated with favorable long-term results and should be considered as the material of first choice for vertebral body and disc replacement.
Authors: Joel S Katz; Chima O Oluigbo; C Corbett Wilkinson; Sean McNatt; Michael H Handler Journal: J Neurosurg Pediatr Date: 2010-05 Impact factor: 2.375