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Management of traumatic spinal injuries in children and young adults

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Abstract

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.

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References

  1. Hamilton MG, Myles ST (1992) Pediatric spinal injury: review of 61 deaths. J Neurosurg 77(5):705–708

    Article  CAS  PubMed  Google Scholar 

  2. Hamilton MG, Myles ST (1992) Pediatric spinal injury: review of 174 hospital admissions. J Neurosurg 77(5):700–704

    Article  CAS  PubMed  Google Scholar 

  3. Ruge JR, Sinson GP, McLone DG, Cerullo LJ (1988) Pediatric spinal injury: the very young. J Neurosurg 68(1):25–30

    Article  CAS  PubMed  Google Scholar 

  4. Dickman CA, Rekate HL, Sonntag VK, Zabramski JM (1989) Pediatric spinal trauma: vertebral column and spinal cord injuries in children. Pediatr Neurosci 15(5):237–255, discussion 256

    Article  CAS  PubMed  Google Scholar 

  5. Evans DL, Bethem D (1989) Cervical spine injuries in children. J Pediatr Orthop 9(5):563–568

    Article  CAS  PubMed  Google Scholar 

  6. Finch GD, Barnes MJ (1998) Major cervical spine injuries in children and adolescents. J Pediatr Orthop 18(6):811–814

    CAS  PubMed  Google Scholar 

  7. Management of pediatric cervical spine and spinal cord injuries (2002). Neurosurgery 50 (3 Suppl):S85–99

  8. McPhee IB (1981) Spinal fractures and dislocations in children and adolescents. Spine 6(6):533–537

    Article  CAS  PubMed  Google Scholar 

  9. Schleehauf K, Ross SE, Civil ID, Schwab CW (1989) Computed tomography in the initial evaluation of the cervical spine. Ann Emerg Med 18(8):815–817

    Article  CAS  PubMed  Google Scholar 

  10. Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR (2001) A prospective multicenter study of cervical spine injury in children. Pediatrics 108(2):E20

    Article  CAS  PubMed  Google Scholar 

  11. Birney TJ, Hanley EN Jr (1989) Traumatic cervical spine injuries in childhood and adolescence. Spine 14(12):1277–1282

    Article  CAS  PubMed  Google Scholar 

  12. Altay M, Ozkurt B, Aktekin CN, Ozturk AM, Dogan O, Tabak AY (2007) Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation in magerl type a fractures. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc 16(8):1145–1155

    Article  Google Scholar 

  13. Basu S (2012) Spinal injuries in children. Front Neurol 3:96

    Article  PubMed Central  PubMed  Google Scholar 

  14. Koop SE, Winter RB, Lonstein JE (1984) The surgical treatment of instability of the upper part of the cervical spine in children and adolescents. J Bone Joint Surg (Am Vol) 66(3):403–411

    CAS  Google Scholar 

  15. Sherk HH, Schut L, Lane JM (1976) Fractures and dislocations of the cervical spine in children. Orthop Clin N Am 7(3):593–604

    CAS  Google Scholar 

  16. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I Paraplegia 7(3):179–192

    Article  CAS  Google Scholar 

  17. Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg (Am Vol) 56(8):1663–1674

    CAS  Google Scholar 

  18. Dogan S, Safavi-Abbasi S, Theodore N, Chang SW, Horn EM, Mariwalla NR, Rekate HL, Sonntag VK (2007) Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases. J Neurosurg 106(6 Suppl):426–433

    PubMed  Google Scholar 

  19. Hadley MN, Zabramski JM, Browner CM, Rekate H, Sonntag VK (1988) Pediatric spinal trauma. Review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 68(1):18–24

    Article  CAS  PubMed  Google Scholar 

  20. Leventhal HR (1960) Birth injuries of the spinal cord. J Pediatr 56:447–453

    Article  CAS  PubMed  Google Scholar 

  21. Ralston ME, Chung K, Barnes PD, Emans JB, Schutzman SA (2001) Role of flexion-extension radiographs in blunt pediatric cervical spine injury. Acad Emerg Med Off J Soc Acad Emerg Med 8(3):237–245

    Article  CAS  Google Scholar 

  22. Vogel LC (1997) Unique management needs of pediatric spinal cord injury patients: etiology and pathophysiology. J Spinal Cord Med 20(1):10–13

    CAS  PubMed  Google Scholar 

  23. Bilston LE, Brown J (2007) Pediatric spinal injury type and severity are age and mechanism dependent. Spine 32(21):2339–2347

    Article  PubMed  Google Scholar 

  24. Bohn D, Armstrong D, Becker L, Humphreys R (1990) Cervical spine injuries in children. J Trauma 30(4):463–469

    Article  CAS  PubMed  Google Scholar 

  25. Gluf WM, Brockmeyer DL (2005) Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients. J Neurosurg Spine 2(2):164–169

    Article  PubMed  Google Scholar 

  26. Rauhut F, Roosen K, Grote W (1984) Surgical treatment of cervical spine injuries in childhood with special reference to the morphological and functional characteristics of the cervical vertebrae. Z Kinderchir Organ Dtsch Schweizerischen Osterreichischen Ges Kinderchir Surg Infancy Childhood 39(3):155–159

    CAS  Google Scholar 

  27. Roosen K, Rauhut F, Maksoud M (1984) Cervical spine injuries in childhood. Conservative treatment or surgery? Neurochirurgia 27(1):1–5

    CAS  PubMed  Google Scholar 

  28. Santiago R, Guenther E, Carroll K, Junkins EP Jr (2006) The clinical presentation of pediatric thoracolumbar fractures. J Trauma 60(1):187–192

    Article  PubMed  Google Scholar 

  29. Aufdermaur M (1974) Spinal injuries in juveniles. Necropsy findings in twelve cases. J Bone Joint Surg Br Vol 56B(3):513–519

    CAS  Google Scholar 

  30. Townsend EH Jr, Rowe ML (1952) Mobility of the upper cervical spine in health and disease. Pediatrics 10(5):567–574

    PubMed  Google Scholar 

  31. Parent S, Dimar J, Dekutoski M, Roy-Beaudry M (2010) Unique features of pediatric spinal cord injury. Spine 35(21 Suppl):S202–S208

    Article  PubMed  Google Scholar 

  32. Anderson JM, Schutt AH (1980) Spinal injury in children: a review of 156 cases seen from 1950 through 1978. Mayo Clin Proc 55(8):499–504

    CAS  PubMed  Google Scholar 

  33. Hedequist DJ, Hall JE, Emans JB (2004) The safety and efficacy of spinal instrumentation in children with congenital spine deformities. Spine 29(18):2081–2086, discussion 2087

    Article  PubMed  Google Scholar 

  34. Katz JS, Oluigbo CO, Wilkinson CC, McNatt S, Handler MH (2010) Prevalence of cervical spine injury in infants with head trauma. J Neurosurg Pediatr 5(5):470–473

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.

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Correspondence to Neriman Özkan.

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Özkan, N., Wrede, K., Ardeshiri, A. et al. Management of traumatic spinal injuries in children and young adults. Childs Nerv Syst 31, 1139–1148 (2015). https://doi.org/10.1007/s00381-015-2698-2

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  • DOI: https://doi.org/10.1007/s00381-015-2698-2

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