Associated injuries in children and adolescents with spinal trauma

Over half of children and adolescents with spinal trauma have associated injuries, most commonly involving the appendicular skeleton, head and neck, and thorax. The incidence and characteristics of these associated injuries have been well described, but to our knowledge there has been no evaluation of the relationship between the injury characteristics and the patient age.

Data were obtained from the trauma registries of the local pediatric and adult level 1 trauma centers, and patients aged 0 to 19 years with spinal trauma were identified. For analysis, patients were divided into 3 age groups: 0 to 3, 4 to 12, and 13 to 19 years. Associated injuries were divided into 5 groups: head, thoracic, abdominal, appendicular skeletal fracture, and neurological.

Overall, 25 patients had isolated dislocations and 307 patients had 366 spinal fractures or fracture-dislocations: 36% cervical, 31% thoracic, and 51% lumbar. Most (84%) of the injuries occurred in the 13- to 19-year-old group. Sixty-two percent of patients had associated injuries, most commonly thoracic injuries (pulmonary contusion, pneumothorax, rib fracture); 45% had multilevel spinal fractures, 39% of which were noncontiguous. Nearly three fourths of the noncontiguous fractures occurred in a different spinal region; cervical fracture with concomitant thoracic fracture was the most frequent pattern.

This large series of consecutive patients highlights several important concepts concerning pediatric spinal fractures, including age-related patterns of injury, frequent associated injuries, and a high rate of multiple spinal injuries, especially noncontiguous injuries. It also emphasizes the importance of careful full-body examination and imaging of the entire spine in children and adolescents with a known spinal injury.

Level IV-case series.