Relative comparison of spinal deformity between pediatric high-impact and geriatric low-impact fractures

Spinal stress fractures are common among young athletes due to high-intensity training and repetitive spinal loading. Elderly individuals also exhibit high rates of spinal fractures, primarily due to age-related bone degeneration. This study aimed to compare fracture severity between pediatric patients experiencing high-energy mechanical injuries and geriatric patients sustaining low-energy injuries.

This 10-year retrospective review included patients from a single center. Pediatric patients (<18 years) were included if they sustained injuries from exercise or motor vehicle collisions and were diagnosed with spinal stress fractures, spondylosis, spondylolisthesis, or spondylolysis. Geriatric patients (>60 years) were included if they had spinal injuries from ground-level falls. Fractures were graded using the arbeitsgemeinschaft für osteosynthesefragen (AO) thoracolumbar classification. Fisher's test, Welch's t-test, and the Mann-Whitney U-test were used to assess statistical differences.

Ninety patients were analyzed (47 pediatric, 43 geriatric). No significant difference was found in thoracolumbar grading levels between age groups (P = 0.244), but geriatric patients had significantly higher median injury severity (P = 0.005). All geriatric patients and 92% of pediatric patients had Type A (compression) fractures. A0 fractures were more common in pediatric (30%) than geriatric (7%) patients. A1 fractures occurred in 51% of geriatric and 49% of pediatric patients. A2 fractures were seen in 7% of geriatric patients only. A3 and A4 fractures were more prevalent in geriatric patients (23% and 12%, respectively) than in pediatric patients (16% and 5%).

Thoracolumbar fracture patterns were similar between age groups, but elderly patients had more severe subtype injuries, likely reflecting the impact of age-related bone fragility.