An Update Review of Epidemiology, Anatomy, Classification, Management and Outcome of pediatric Thoracolumbar Spine Trauma

Abstract

Context: The incidence of vertebral column and spinal cord damage in children in the current century is greater than ever. Thoracolumbar fractures are extra numerous in teenagers, the most common reasons are falling from a height and motorcycle accidents. The current study aimed at designing a straightforward assessment of the epidemiology, anatomy, biomechanics, and clinical detection and managing plans for children with thoracolumbar traumas. Evidence Acquisition: Totally, 85 articles conducted from 1970 to 2016 were studied. A total of 63 articles were included in the current pediatric evaluation. But, based on the philosophy of the current study, just newly published studies from 2000 on spinal trauma epidemiology, classification, and management were included. Results: Spinal fractures in pediatrics characterize 1% or 2% of all pediatric fractures, and most of the damage comprise the cervical spinal column. The mainstream of thoracolumbar spinal column fractures in the children happen at the age of 14 to 16 years. The most common damaged zone of the spine is T4 to T12, followed by T12 to L2 based on the patients' age and type of radiologic classification of trauma, and conservative or surgery treatments may be used for the fractures. Conclusions: Forceful use of computed tomography (CT) scan and magnetic resonance imaging (MRI) can classify delicate thoracolumbar damages and involvement of neural components and offer prognostic data in children with possible neurologic recovery, especially in SCIWORA (spinal cord injury without radiographic abnormality) type of injury. Currently, classification of the thoracolumbar injury and severity scales (TLISS) is generally useful in the adults by means of trauma to define non-operative vs. operative management of spine fractures. This classification is newly considered in the pediatric population, and there are reports on the outstanding validity of this system, similar to adults. Usually, various stable fractures can be cured conservatively, while unstable fractures need surgical stabilization.

Clinical Characteristics of Pediatric Thoracolumbar Spinal Injuries: A Retrospective Study

“…(14) Between 3.3% and 34% of reported series had SCIWORA as an occurrence. The thoracic cord is involved in around 13% of instances with SCIWORA (15,16) (17)In comparison to the cervical cord, the thoracic cord has a reduced incidence of SCIWORA. Similar to what was seen in the previous investigations, the incidence of SCIWORA of the thoracic cord in the current series was 6.4% (2/34).As a result of our selection criteria for surgical intervention, which excluded patients with full cord damage from consideration for surgery during the acute phase, 20% (18/90) of the patients in our research had surgical intervention.…”

“…In our study, the majority of children (16)(17)(18)) received posterior transpedicular fusion, which included the vertebrae above and below the broken one. A combined anterior and posterior approach & 360° fusion were performed on two patients.…”

Evaluation and Management of Thoracolumbar Spine Trauma in Pediatric Patients

“…In very young, neurologically intact patients, some types of unstable fracture patterns, such as burst fractures and bony chance fractures, can be treated nonoperatively with cast immobilization 60 . For unstable fractures or injuries with associated neurologic deficits, operative stabilization (anterior or posterior instrumentation and fusion) with or without decompression is indicated 61 . An additional consideration in the pediatric population is whether considerable deformity may result from their vertebral injury.…”