Treatment of spinal fractures in children and adolescents: Long-term results in 44 patients

Study Design. The authors examined a case series of patients younger than 16 years who had sustained a traumatic spine injury. Objectives. To evaluate clinical and radiologic findings and the effectiveness of conservative versus surgical treatment at long-term follow-up. Summary of Background Data. Although injuries to children have received increasing coverage in the literature over the last several years, few reports have focused on the long-term results of conservative versus surgical treatment. Methods. Forty-four patients who had sustained a traumatic spine injury at the average age of 14 years (range 3-16 years) were clinically and radiographically reviewed. The fractures were separated into three groups: stable (n = 20) and unstable (n = 13) injuries without cord lesion and fractures with spinal cord lesion (n = 11). Mean follow-up was 18 years (range 9-23 years). Results. Conservative treatment was successful in all stable fractures, whereas it failed in the unstable injuries. The surgical treatment stabilized without significant deformity in five of the seven unstable fractures. Of 11 with spinal cord injuries, the 4 children conservatively treated developed a severely progressive, paralytic scoliosis. Only three of the seven surgically treated patients were stabilized without any deformity at follow-up. Conclusion. In children and adolescents, conservative treatment is an available option for stable fractures without neurologic lesion. Early surgical treatment (instrumentation and fusion) is mandatory for unstable fractures and injuries associated with spinal cord lesion. In children, a traumatic spinal cord lesion may develop a deformity that is mainly scoliotic, kyphotic, or lordotic in >90% of the cases.