Citation

Firth GB, Kingwell S, Moroz P. Spine 2011; ePub(ePub): ePub.

Affiliation

University of Ottawa, Department of Surgery, Division of Pediatric Orthopaedic Surgery, The Children's Hospital of Eastern Ontario.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e31824079ea

PMID

22089399

Abstract

Study Design. Retrospective review.Objective. To determine the incidence and clinical characteristics of non-contiguous spinal injuries in a pediatric population. The secondary objective is to identify high risk patients requiring further imaging to rule out non-contiguous spinal injuries.Summary of Background Data. Non-contiguous spinal injury can add significant complexity to the diagnosis, management and outcome of children. There is very little in the pediatric literature examining the nature, associated risk factors, management and outcomes of non-contiguous spinal injuries.Methods. All children up to 18 years of age with a spinal injury, as defined by ICD-09 codes at one pediatric trauma hospital were included (n = 211). Data for patient demographics, mechanism of injury, spinal levels involved, extent of neurologic injury and recovery, associated injuries, medical complications, treatment and outcome was recorded.Results. Twenty five (11.8%) out of 211 patients had non-contiguous spinal injuries with a median age of 13.0 years (IQR 8-15). The most common pattern of injury was a double thoracic non-contiguous injury. 16% of cases of NCSI were initially missed, with no clinical deterioration due to missed diagnosis. Associated injuries occurred in 44% of patients with NCSI. Twenty-four percent of patients with multiple non-contiguous spinal injuries had a neurologic injury compared to 9.7% in patients with single level or contiguous injuries (p = 0.046).Conclusions. There is a high incidence of children with multiple non-contiguous spinal injuries who are more likely to suffer neurological injuries compared to patients with single level or contiguous spinal injuries. Patients with a single level spinal injury on existing imaging and a neurological injury should have entire spine lateral radiographs to exclude non-contiguous injuries. In patients without neurologic injury and a single spinal fracture, radiographs showing at least four levels above and below the fracture should be performed. All children with spinal injury should have associated injuries carefully excluded.

Language: en