Treatment of Spinal Fractures in Children and Adolescents: Long-Term Results in 44 Patients

Spine Surgery Department, Istituto Ortopedico Rizzoli, Bologna, Italy

PURPOSE: A retrospective review was performed to investigate 44 patients treated for spinal fracture during growth.

METHODS: From 1976 to 1988, 44 patients (27 males -17 females) aged 14 years on average (range, 3 to 16 years) were surgically or nonsurgically treated at our Department for spinal trauma.

RESULTS: The 44 patients were reviewed at a mean interval of 18 years (range, 9 to 23 years), when they were 33 on average (range, 23 to 39 years). They were divided into 2 groups according to the neurologic picture.

Neurologically Intact Group (33 patients)
In 21 neurologically intact patients presenting stable upper cervical fractures (3), thoracic compression fractures (11) and thoraco-lumbar burst type A fractures (7), non-operative treatment ensured a quite normal reconstruction of the vertebral body height; however, burst type A fractures resulted in segmental kyphosis or scoliosis, never exceeding 10°.

The other 12 neurologically intact patients (3 burst fractures, 4 seat-belt fractures, 3 fracture-dislocations, 1 tear-drop and 1 severe cervical distortion) resulted in late deformity in 5 of the 6 non-surgically treated cases (mean values of kyphosis and scoliosis: 20° and 18°, respectively). Surgical treatment (posterior reduction-instrumentation) ensured good long-term results only in the 3 cervical cases (Roy-Camille plates), while 2 of the 3 thoraco-lumbar fractures with seat-belt injury resulted in post-traumatic deformity (mean value: kyphosis 17°, scoliosis 31°).

Neurologic Lesions Group (11 patients)
Four (1 burst type, 1 seat-belt injury, 2 SCIWORA) of the 11 patients with neurologic lesions (3 tetraparesis, 5 paraplegia and 3 paraparesis) underwent non-operative treatment, which rapidly resulted in paralytic scoliosis (3 cases) and segmental kyphosis (1 case) requiring later surgical treatment. Four of the 7 surgically treated patients (1 laminectomy and 6 posterior instrumentation) showed a neurological recovery, while 3 with pre-operative paraplegia remained unchanged. A late deformity (kyphosis exceeding 90°) occurred only in the laminectomy case.

CONCLUSIONS: Simple thoracic compression fractures non-surgically treated, did not affect standard vertebral development. Unstable fractures presented with unfavorable prognostic aspects, progressing towards a deformity after non-surgical treatment. In these cases, prompt surgical treatment is recommended and becomes mandatory in case of lesions with neurological impairment.