A retrospective and prospective study of spinal injuries in children and adolescent- incidence etiology and early outcome

Abstract

BackgroundTraumatic spinal injuries in children consists up to 10% of all reported spinal injuries. The true incidence may be underestimated because of mortality at the site or during transport. The level of injury and incidence of neurological compromise varies with the age of child. The infants, toddlers, school age children and adolescents have distinctive anatomic and biomechanical spinal features and behavioral patterns that distinguish them not only from adults but also from each other in this study we analyses all parameter of differences. Material And MethodThis is a two years retrospective and one year prospective study of spinal injuries in children and adolescent age up to 18 years admitted in spinal injury unit of orthopaedics surgery King George ’ s Medical University Lucknow to evaluate incidence, etiology and early outcome. Following variables were studied in these retrospective and prospective-(1) age and sex (2) injury mechanism (3) associated injuries (4) injury level (neurological and radiological) (5) management and early outcome (6) deformity evaluation ResultTotal number of patients was 82 of which 68 were retrospective and 26 were prospective, incidence was 13.21/ year/1000, male female ratio 3.1:1, no infant, toddlers -6(7.31%) ,school going 17(21.73%) ,adolescent 59(71.95%). Most common mechanism of injury was fall from height followed by road traffic accident, most common neurological and radiological level C5-C7, conservative management done in 78 and operative in 4 patients of which 35 improve, 23 not improve, 16 drop out and 4 expired. In prospective study FIM score increase in all patient except one and Barthal index not improve in two patients. Deformity present in 21 prospective and 4 retrospective patients kyphotic deformity of >15 degree found in13 patients a mild progression of 4.23 degree was noted in follow up. ConclusionsIn children and adolescent the incidence of spinal injury, mechanism of injury, neurological and vertebral level are different at different age groups and outcome is depends on extent of injury complete(A), incomplete(B,C,D) of ASIA impairment scale and motor and sensory score after spinal shock is over. The development of deformity is determined by age, extent of injury, vertebral level at the time of injury. Keywords––Demography, functional independence measure (FIM), Cobb’s angle, and Barthal index.