Pediatric Blunt Thoracolumbar Spinal Injury: Defining the Burden of Injury and Imaging Practices

Surgical intervention for thoracolumbar spinal injury (TLSI) is rare in pediatric trauma. Current guidelines recommend CT scanning of the entire spine if one spinal injury is found, and localized CT if spinal injury is suspected, likely resulting in significant radiation exposure for these injuries. This study identifies the frequency of various imaging techniques utilized across trauma centers of varied designations for confirmed pediatric TLSI.

The American College of Surgeons Trauma Quality Improvement Program Participant Use File (TQIP PUF) was queried from 2017 to 2022. Patients aged younger than or equal to 14 years with thoracic or lumbar injuries were included. ICD-10 codes for injuries, imaging, procedures, and bracing were analyzed by patient age and trauma center level.

Thirteen thousand three hundred ten children were identified with blunt TLSI. The most common injury was thoracic spine fracture (58.23%) followed by lumbar spine fracture (45.11%). Spinal cord injuries were less common (5.8% lumbar, 7.18% thoracic), as were joint injuries (5.8% lumbar, 0.86% thoracic). The need for surgical intervention was rare (6.49%) and varied significantly with age and trauma center type. Older children were more likely to be evaluated with CT and younger children were more likely to be evaluated with MRI. Adult centers were much more likely to image with CT, and pediatric centers were much more likely to use plain film or MRI.

Although TLSI is common in blunt pediatric trauma, intervention is rarely needed. CT imaging is liberally used, particularly in adult trauma centers. Improved guidelines for cross-sectional imaging in neurologically normal patients are needed.