Pe d i a t r i c I m a g i n g • R ev i ew Junewick et al. Pediatric Thoracic Spine Injuries
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Pediatric Imaging Review
Pediatric Thoracic Spine Injuries: A Single-Institution Experience Joseph J. Junewick1,2,3 Heather L. Borders1,2,3 Alan T. Davis 4,5 Junewick JJ, Borders HL, Davis AT
OBJECTIVE. The objective of our study was to determine the incidence of various fractures of the thoracic spine in pediatric patients. CONCLUSION. Simple compression and process-only fractures were the most common types of fractures and all other fracture types were infrequent. Distraction injury was unexpectedly more common in the nonjunctional thoracic spine than in the junctional thoracic spine.
S
Keywords: distraction fracture, flexion-distraction injury, pediatric thoracic spine fracture DOI:10.2214/AJR.13.12143 Received October 29, 2013; accepted after revision December 12, 2013. 1 Department of Radiology, Helen DeVos Children’s Hospital, 100 Michigan Ave, Grand Rapids, MI 49503. Address correspondence to H. L. Borders (
[email protected]). 2
Department of Radiology, Michigan State University, College of Human Medicine, Grand Rapids, MI. 3
Advanced Radiology Services, Grand Rapids, MI.
4 Research Department, Grand Rapids Medical Education Partners, Grand Rapids, MI. 5 Department of Surgery, Michigan State University, College of Human Medicine, Grand Rapids, MI.
This article is available for credit. AJR 2014; 203:649–655 0361–803X/14/2033–649 © American Roentgen Ray Society
pine trauma is often designated by the following anatomic levels: cervical, thoracic, lumbar (nonjunctional), and junctional (craniocervical, cervicothoracic, and thoracolumbar). Different types and distributions of injuries are seen in pediatric patients compared with adults because of anatomic and biomechanical differences. The pediatric spine is more flexible and is not completely ossified compared with the adult spine, and the muscles of pediatric patients are typically weaker than those of adults. Additionally, the ligaments of pediatric patients are more elastic and the facet joints are more shallow [1–4]. These differences decrease as a patient approaches skeletal maturity. The purpose of this study was to determine the incidence of various injury patterns of the thoracic vertebrae in infants and children. Materials and Methods Institutional review board approval was given to review the records of all pediatric patients ( 0.99
1/32 (3.1)
0.38
1/6 (16.7)
4/68 (5.9)
0.35
1/32 (3.1)
> 0.99
0/6 (0.0)
3/68 (4.4)
> 0.99
Burst fracture
2/42 (4.8)
1/32 (3.1)
> 0.99
0/6 (0.0)
3/68 (4.4)
> 0.99
Hyperextension-distraction
2/42 (4.8)
0/32 (0.0)
0.50
1/6 (16.7)
1/68 (1.5)
0.16
Hyperflexion-distraction
2/42 (4.8)
4/32 (12.5)
0.39
1/6 (16.7)
5/68 (7.4)
0.41
Fracture-dislocation
2/42 (4.8)
0/32 (0.0)
0.50
0/6 (0.0)
2/68 (2.9)
> 0.99
Process-only fracture
15/42 (35.7)
12/32 (37.5)
> 0.99
3/6 (50.0)
24/68 (35.3)
0.66
1/42 (2.4)
0/32 (0.0)
> 0.99
0/6 (0.0)
1/68 (1.5)
> 0.99
Other aData are presented as no. of patients/total no. of patients (%).
bAny loss of vertebral body height with facet dispuption or an interspinous ligament or posterior ligamentous complex injury.
TABLE 2: Fracture Type by Presence of Brain Injury or Abdominal Visceral Injury Brain Injury
Abdominal Visceral Injury
Yesa
Noa
Simple compression
7/14 (50.0)
44/60 (73.3)
Unstable compressionb
0/14 (0.0)
5/60 (8.3)
0.58
Lateral compression
0/14 (0.0)
3/60 (5.0)
> 0.99
Burst fracture
0/14 (0.0)
3/60 (5.0)
> 0.99
Hyperextension-distraction
0/14 (0.0)
2/60 (3.3)
> 0.99
Fracture Type
p
Yesa
Noa
p
0.11
10/18 (55.6)
41/56 (73.2)
0.16
1/18 (5.6)
4/56 (7.1)
> 0.99
0/18 (0.0)
3/56 (5.4)
> 0.99
1/18 (5.6)
2/56 (3.6)
> 0.99
2/18 (11.1)
0/56 (0.0)
0.06
Hyperflexion-distraction
1/14 (7.1)
5/60 (8.3)
> 0.99
1/18 (5.6)
5/56 (8.9)
> 0.99
Fracture-dislocation
0/14 (0.0)
2/60 (3.3)
> 0.99
0/18 (0.0)
2/56 (3.6)
> 0.99
Process-only fracture
9/14 (64.3)
18/60 (30.0)
0.02
9/18 (50.0)
18/56 (32.1)
0.17
Other
0/14 (0.0)
1/60 (1.7)
> 0.99
0/18 (0.0)
1/56 (1.8)
> 0.99
aData are presented as no. of patients/total no. of patients (%).
bAny loss of vertebral body height with facet dispuption or an interspinous ligament or posterior ligamentous complex injury.
650
AJR:203, September 2014
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Pediatric Thoracic Spine Injuries Fracture types were also compared based on junctional (T1, T11, or T12) versus nonjunctional (T2–T10) segments of the thoracic spine. Simple compression, unstable compression, hyperflexion-distraction, and processonly fractures were significantly more prevalent in the nonjunctional thoracic segments than in the junctional thoracic segments (p