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Published on: January 5, 2015
Pediatric noncontiguous spinal injuries: the 15-year experience at a level 1 trauma center
Gregory B Firth1, Stephen P Kingwell, Paul J Moroz
1Department of Surgery, Division of Pediatric Orthopaedic Surgery, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Insights
Pediatric noncontiguous spinal injuries (NCSI) occur in 11.8% of children with spinal trauma. Multiple NCSI correlate with a higher risk of neurological injury, necessitating thorough spinal imaging.
Area of Science:
- Pediatric Traumatology
- Spinal Injury Management
- Radiographic Imaging in Children
Background:
- Noncontiguous spinal injuries (NCSI) present diagnostic and management challenges in pediatric patients.
- Limited pediatric literature exists on the characteristics, risk factors, and outcomes of NCSI.
- NCSI can significantly complicate care and affect outcomes in children.
Observation:
- A retrospective review of 211 pediatric spinal injury cases identified an 11.8% incidence of NCSI.
- The median age of pediatric patients with NCSI was 13 years.
- Double thoracic injuries were the most common NCSI pattern.
Findings:
- 16% of NCSI cases were initially missed without apparent clinical deterioration.
- Associated injuries were present in 44% of NCSI patients.
- Patients with multiple NCSI had a significantly higher incidence of neurological injury (24%) compared to single-level or contiguous injuries (9.7%).
Implications:
- Children with single-level spinal injuries and neurological deficits require full spine imaging to rule out NCSI.
- Radiographic evaluation of pediatric spinal fractures should encompass at least four levels above and below the injury site, especially in neurologically intact patients.
- Comprehensive assessment for associated injuries is crucial in all pediatric spinal trauma cases.
Study Design:
Retrospective review.
Objective:
To determine the incidence and clinical characteristics of noncontiguous spinal injuries (NCSI) in a pediatric population. The secondary objective is to identify high-risk patients requiring further imaging to rule out NCSI.
Summary Of Background Data:
NCSI can add significant complexity to the diagnosis, management, and outcome of children. There is very little in the pediatric literature examining the nature, associated risk factors, management, and outcomes of NCSI.
Methods:
All children up to 18 years of age with a spinal injury, as defined by International Classification of Diseases, Ninth Revision codes, at one pediatric trauma hospital were included (n = 211). Data for patient demographics, mechanism of injury, spinal levels involved, extent of neurological injury and recovery, associated injuries, medical complications, treatment, and outcome were recorded.
Results:
Twenty-five (11.8%) of 211 patients had NCSI, with a median age of 13.0 years (interquartile range = 8-15). The most common pattern of injury was a double thoracic noncontiguous injury. Sixteen percent of the cases of NCSI were initially missed, with no clinical deterioration due to missed diagnosis. Associated injuries occurred in 44% of patients with NCSI. Twenty-four percent of patients with multiple NCSI had a neurological injury compared with 9.7% in patients with single-level or contiguous injuries (P = 0.046).
Conclusion:
There is a high incidence of children with multiple NCSI who are more likely to experience neurological injuries compared with patients with single-level or contiguous spinal injuries. Patients with a single-level spinal injury on existing imaging with an associated neurological injury should undergo at least plain films of the entire spine to exclude noncontiguous injuries. In patients without neurological injury and a single spinal fracture, radiography showing at least 4 levels above and below the fracture should be performed. All children with spinal injury should have associated injuries carefully excluded.
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