Distribution of spinal fractures in children: does age, mechanism of injury, or gender play a significant role?

Abstract

The distribution of fractures in the spine reported in the literature is quite variable. Application of such data to the pediatric population needs to take into account differences between children and adults, including overall decreased fracture frequency in children, developmental and physiological differences, and mechanism of injury. Knowledge of specific regions of injury may alter search patterns and protocols. To determine if the distribution of spinal injuries in pediatric patients is related to age, mechanism of injury, or gender. All pediatric patients (<18 years old) referred to our trauma service over a 5-year period were retrospectively reviewed. All patients with vertebral fracture and/or neurological injury were included. The levels of the spinal fractures were tabulated. Correlation was then made with age, gender, and mechanism of injury (motor vehicle accident versus non-motor vehicle accident). Of the 2614 pediatric patients, 84 sustained vertebral fracture and 50 had neurological injury without radiographic abnormality. A total of 164 fractures were identified. The thoracic region (T2-T10) was most commonly injured, accounting for 47 fractures (28.7%) followed by the lumbar region (L2-L5) with 38 fractures (23.2%), the mid-cervical region with 31 fractures (18.9%), the thoracolumbar junction with 24 fractures (14.6%), the cervicothoracic junction with 13 fractures (7.9%), and the cervicocranium with 11 fractures (6.7%). There was no relationship to gender or mechanism of injury. Regardless of gender or mechanism of injury, the thoracic spine (T2-T10) is the most common region of fracture in pediatric trauma patients.