, Volume 98, Issue 2, pp 107–114 | Cite as

Results of fusion and instrumentation of thoracic and lumbar vertebral fractures in children: a prospective ten-year study

  • M. A. Erfani
  • B. Pourabbas
  • H. Nouraie
  • I. Vadiee
  • A. R. VosoughiEmail author
Original Article



Researches on the results of surgical treatment of thoracolumbar spine fractures are infrequent. The aim of this study was to determine midterm outcomes of surgical treatment of these fractures in a prospective survey.


A case series study on pediatric patients with the diagnosis of thoracic and/or lumbar vertebral fractures was conducted over a ten-year period. Surgically treated patients were evaluated in the follow-up period, based on back pain, independent function, neurological status, and radiographic indices.


There were 102 pediatric individuals, 61 boys and 41 girls, aged 3–17 years (mean 12 years of age) with thoracic and/or lumbar spinal fractures. Motor vehicle accident was the most common mechanism of injury (45.0 %). L1 was the most frequent level of fractured vertebra (24.4 %), and pelvic fracture was the most common associated orthopedic injury (21.5 %). Totally, 20 patients underwent surgery, but only fifteen (14 boys and one girl) participated in follow-up (mean 49 months; range 12–81 months). Posterior spinal fusion and instrumentation was accomplished in 12 cases. Three patients were operated by anterior approach and fusion followed by posterior fusion and instrumentation because of delay in diagnosis. There were no major perioperative complications. Two cauda equina syndromes and two incomplete spinal cord injuries improved back to normal. Five cases (33.3 %) reported occasional back pain, and all patients were functionally independent. Radiographic indices improved significantly.


Spinal fusion and instrumentation in pediatric patients with unstable thoracolumbar vertebral fractures with or without spinal cord injuries have favorable radiographic and functional outcomes.


Spine Children Vertebra Fracture 



This article has been extracted from a thesis submitted to Shiraz University of Medical Sciences in partial fulfillment of the requirement for the degree of specialty in orthopedic surgery. Source of funding is Bone and Joint Disease Research Center of Shiraz University of Medical Sciences.

Conflict of interest



  1. 1.
    Basu S (2012) Spinal injuries in children. Front Neurol 3:96PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Bernstein MP, Mirvis SE, Shanmuganathan K (2006) Chance-type fractures of the thoracolumbar spine: imaging analysis in 53 patients. AJR Am J Roentgenol 187:859–868PubMedCrossRefGoogle Scholar
  3. 3.
    Bilston LE, Brown J (2007) Pediatric spinal injury type and severity are age and mechanism dependent. Spine (Phila Pa 1976) 32:2339–2347CrossRefGoogle Scholar
  4. 4.
    Bradford DS, McBride GG (1987) Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res 218:201–216PubMedGoogle Scholar
  5. 5.
    Calenoff L, Chessare JW, Rogers LF, Toerge J, Rosen JS (1978) Multiple level spinal injuries: importance of early recognition. AJR Am J Roentgenol 130:665–669PubMedCrossRefGoogle Scholar
  6. 6.
    Carreon LY, Glassman SD, Campbell MJ (2004) Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech 17:477–482PubMedCrossRefGoogle Scholar
  7. 7.
    Cicala D, Briganti F, Casale L, Rossi C, Cagini L, Cesarano E, Brunese L, Giganti M (2013) Atraumatic vertebral compression fractures: differential diagnosis between benign osteoporotic and malignant fractures by MRI. Musculoskelet Surg 97(Suppl 2):S169–S179PubMedCrossRefGoogle Scholar
  8. 8.
    Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN (2004) Spinal injuries in children. J Pediatr Surg 39:607–612PubMedCrossRefGoogle Scholar
  9. 9.
    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 106:426–433PubMedGoogle Scholar
  10. 10.
    Farcy JP, Weidenbaum M, Glassman SD (1990) Sagittal index in management of thoracolumbar burst fractures. Spine (Phila Pa 1976) 15:958–965CrossRefGoogle Scholar
  11. 11.
    Firth GB, Kingwell SP, Moroz PJ (2012) Pediatric noncontiguous spinal injuries: the 15-year experience at 1 pediatric trauma center. Spine (Phila Pa 1976) 37:E599–E608CrossRefGoogle Scholar
  12. 12.
    Groves CJ, Cassar-Pullicino VN, Tins BJ, Tyrrell PN, McCall IW (2005) Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology 236:601–608PubMedCrossRefGoogle Scholar
  13. 13.
    Hamilton BB, Laughlin JA, Fiedler RC, Granger CV (1994) Interrater reliability of the 7-level functional independence measure (FIM). Scand J Rehabil Med 26:115–119PubMedGoogle Scholar
  14. 14.
    Hamilton MG, Myles ST (1992) Pediatric spinal injury: review of 174 hospital admissions. J Neurosurg 77:700–704PubMedCrossRefGoogle Scholar
  15. 15.
    Hedequist DJ, Hall JE, Emans JB (2004) The safety and efficacy of spinal instrumentation in children with congenital spine deformities. Spine (Phila Pa 1976) 29:2081–2086CrossRefGoogle Scholar
  16. 16.
    Hofbauer M, Jaindl M, Höchtl LL, Ostermann RC, Kdolsky R, Aldrian S (2012) Spine injuries in polytraumatized pediatric patients: characteristics and experience from a Level I trauma center over two decades. J Trauma Acute Care Surg 73:156–161PubMedCrossRefGoogle Scholar
  17. 17.
    Junkins EP Jr, Stotts A, Santiago R, Guenther E (2008) The clinical presentation of pediatric thoracolumbar fractures: a prospective study. J Trauma 65:1066–1071PubMedCrossRefGoogle Scholar
  18. 18.
    Kraus R, Stahl JP, Heiss C, Horas U, Dongowski N, Schnettler R (2013) Fractures of the thoracic and lumbar spine in children and adolescents. Unfallchirurg 116:435–441PubMedCrossRefGoogle Scholar
  19. 19.
    Leonard M, Sproule J, McCormack D (2007) Paediatric spinal trauma and associated injuries. Injury 38:188–193PubMedCrossRefGoogle Scholar
  20. 20.
    Leucht P, Fischer K, Muhr G, Mueller EJ (2009) Epidemiology of traumatic spine fractures. Injury 40:166–172PubMedCrossRefGoogle Scholar
  21. 21.
    Mahan ST, Mooney DP, Karlin LI, Hresko MT (2009) Multiple level injuries in pediatric spinal trauma. J Trauma 67:537–542PubMedCrossRefGoogle Scholar
  22. 22.
    Mohanty SP, Bhat SN, Ishwara-Keerthi C (2011) The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures. Musculoskelet Surg 95:101–106PubMedCrossRefGoogle Scholar
  23. 23.
    Moller A, Hasserius R, Besjakov J, Ohlin A, Karlsson M (2006) Vertebral fractures in late adolescence: a 27 to 47-year follow-up. Eur Spine J 15:1247–1254PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Mortazavi MM, Dogan S, Civelek E, Tubbs RS, Theodore N, Rekate HL, Sonntag VK (2011) Pediatric multilevel spine injuries: an institutional experience. Childs Nerv Syst 27:1095–1100PubMedCrossRefGoogle Scholar
  25. 25.
    Parente A, Navascués JA, Hernández E, Sánchez-París O, Cañizo A, Cerdá J, Molina E, De Tomás E, De Agustín JC, Matute JA, Vázquez J (2005) Spinal cord and vertebral column injuries in children. Cir Pediatr 18:132–135PubMedGoogle Scholar
  26. 26.
    Parisini P, Di Silvestre M, Greggi T (2002) Treatment of spinal fractures in children and adolescents: long-term results in 44 patients. Spine (Phila Pa 1976) 27:1989–1994CrossRefGoogle Scholar
  27. 27.
    Papavasiliou A, Stanton J, Sinha P, Forder J, Skyrme A (2007) The complexity of seat belt injuries including spinal injury in the pediatric population: a case report of a 6-year-old boy and the literature review. Eur J Emerg Med 14:180–183PubMedCrossRefGoogle Scholar
  28. 28.
    Puisto V, Kääriäinen S, Impinen A, Parkkila T, Vartiainen E, Jalanko T, Pakarinen MP, Helenius I (2010) Incidence of spinal and spinal cord injuries and their surgical treatment in children and adolescents: a population-based study. Spine (Phila Pa 1976) 35:104–107CrossRefGoogle Scholar
  29. 29.
    Reddy SP, Junewick JJ, Backstrom JW (2003) Distribution of spinal fractures in children: does age, mechanism of injury, or gender play a significant role? Pediatr Radiol 33:776–781PubMedCrossRefGoogle Scholar
  30. 30.
    Rumball K, Jarvis J (1992) Seat-belt injuries of the spine in young children. J Bone Joint Surg Br 74:571–574PubMedGoogle Scholar
  31. 31.
    Santiago R, Guenther E, Carroll K, Junkins EP Jr (2006) The clinical presentation of pediatric thoracolumbar fractures. J Trauma 60:187–192PubMedCrossRefGoogle Scholar
  32. 32.
    Strømsøe K, Magnaes B, Nakstad P (2000) Open reduction and internal fixation in flexion-distraction injuries to the lower spine in children and adolescents involved in traffic accidents as car occupants. A report and literature review. Arch Orthop Trauma Surg 120:96–99PubMedGoogle Scholar
  33. 33.
    Stulík J, Pesl T, Kryl J, Vyskocil T, Sebesta P, Havránek P (2006) Spinal injuries in children and adolescents. Acta Chir Orthop Traumatol Cech 73:313–320PubMedGoogle Scholar
  34. 34.
    Turgut M, Akpinar G, Akalan N, Ozcan OE (1996) Spinal injuries in the pediatric age group: a review of 82 cases of spinal cord and vertebral column injuries. Eur Spine J 5:148–152PubMedCrossRefGoogle Scholar
  35. 35.
    Vander Have KL, Caird MS, Gross S, Farley FA, Graziano GA, Stauff M, Segal LS (2009) Burst fractures of the thoracic and lumbar spine in children and adolescents. J Pediatr Orthop 29:713–719PubMedCrossRefGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2014

Authors and Affiliations

  • M. A. Erfani
    • 1
  • B. Pourabbas
    • 1
  • H. Nouraie
    • 1
  • I. Vadiee
    • 1
  • A. R. Vosoughi
    • 1
    Email author
  1. 1.Bone and Joint Disease Research Center, Department of Orthopedic Surgery, Chamran HospitalShiraz University of Medical SciencesShirazIran

Personalised recommendations