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Pediatric multilevel spine injuries: an institutional experience
Martin M Mortazavi1, Seref Dogan, Erdinc Civelek
1Division of Neurological Surgery, and Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Insights
Multilevel spine injuries in children are most common in adolescents aged 9-16, primarily affecting the cervical region. Management principles for these injuries mirror those for single-level spinal trauma, guided by stability and neurological status.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Trauma Surgery
Background:
- Spinal column trauma is rare in children (1-2% of fractures).
- Pediatric spinal injuries can affect multiple vertebral levels.
- Understanding injury patterns is crucial for effective management.
Purpose of the Study:
- To evaluate injury mechanisms and patterns in pediatric multilevel spine injuries.
- To identify factors influencing management and outcomes.
- To analyze treatment strategies for pediatric spinal trauma.
Main Methods:
- Retrospective review of 183 pediatric spine injury patients.
- Analysis of 48 patients with multilevel spinal injuries (mean age 12.8 years).
- Categorization of injuries by level (contiguous/noncontiguous) and region (cervical, thoracic).
Main Results:
- Multilevel injuries occurred in 26.2% of patients, predominantly in those aged 9-16.
- Cervical spine was the most frequently involved region (31.2%).
- Most patients (73%) remained neurologically intact; 8.3% had complete spinal cord injury (SCI).
- Conservative treatment was used in 75% of cases; 25% underwent surgery.
- Mortality rate was 6.2%.
Conclusions:
- Pediatric multilevel spine injuries are most prevalent in older children (9-16 years) and often involve the cervical spine.
- The upper (rostral) injury is frequently linked to neurological deficits.
- Treatment decisions for multilevel spine injuries should prioritize spinal stability and neurological status, similar to single-level injuries.
Object:
Spinal column trauma is relatively uncommon in the pediatric population, representing 1-2% of all pediatric fractures. However, pediatric spinal injury at more than one level is not uncommon. The purpose of this study was to evaluate the mechanisms and patterns of the injury and factors affecting management and outcomes of pediatric multilevel spine injuries.
Patients And Methods:
Patients with pediatric spine injury (183) were retrospectively reviewed. Patients (28 boys, 20 girls; mean age 12.8 years; range 3 to 16 years) identified with multilevel spinal injuries were 48 (26.2%): 7 patients (14.5%) were between 3 and 9 years of age, and 41 patients (85.5%) were between 9 and 16 years of age. Of the 48 patients, 30 (62.5%) were at contiguous levels and 18 (37.5%) were at noncontiguous. A total of 126 injured vertebrae were diagnosed. The cervical region alone was most frequently (31.2%) involved, and the thoracic region alone was the least frequently involved (12.5%). Overall, 73% of patients were neurologically intact, 4.1% had incomplete spinal cord injury (SCI), and 8.3% had complete SCI. Treatment was conservative in 36 (75%) patients. Surgical treatments were done in 12 patients (25%). Postoperatively, one patient (16.6%) with initial neurologic deficit improved. The overall mortality rate was 6.2%.
Conclusions:
Multilevel spine injuries are most common in children between 9 and 16 years of age and are mainly located in the cervical region. The rostral injury was most often responsible for the neurologic deficit. The treatment of multilevel spine injuries should follow the same principles as single level injury, stability and neurologic symptoms indicate the appropriate treatment.
