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Conservative treatment of pediatric thoracic and lumbar spinal fractures

Angelliaume, Audrey and Simon, Anne-Laure and Boissière, Louis and Bouty, Aurore and Sales de Gauzy, Jérôme and Vital, Jean-Marc and Gille, Olivier and Tournier, Clément and Aunoble, Stéphane and Pontailler, Jean-Roger and Lefèvre, Yan Conservative treatment of pediatric thoracic and lumbar spinal fractures. (2017) Journal of Pediatric Orthopaedics B, 26 (1). 73-79. ISSN 1060-152X

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Official URL: https://doi.org/10.1097/BPB.0000000000000329

Abstract

To assess sagittal plane spinopelvic balance and functional outcomes in a pediatric cohort of patients with a thoracic and/or a lumbar fracture treated conservatively. A multicentric study retrospectively reviewed radiological and functional outcomes (mean follow-up 49 months) of 48 patients (mean age 12 years) with thoracic and/or lumbar spinal fractures that occurred between 1996 and 2014. Demographic data and radiological spinopelvic parameters were analyzed. Functional outcome was evaluated by a telephone interview. First, a comparison between the initial and the last follow-up full-spine radiographs was performed for the assessment of bone remodeling and sagittal plane balance. Then, patients were classified into two groups (group 1: Risser≤2 and group 2, Risser>2) to assess the influence of skeletal maturity on the restoration of a correct sagittal balance. A total of 62% of the patients were at skeletal maturity at the final follow-up (Risser 4 and 5). Patients with a Risser grade of 2 or less had a higher remodeling potential. The mean residual local kyphosis in thoracic and lumbar fractures was, respectively, 8.2° and 8.7°. The mean thoracic global kyphosis remains stable at the last follow-up, in contrast to lumbar lordosis, which increased significantly. Sagittal plane global measurements on the basis of the C7-plumbline remained unchanged at the last follow-up. There was no change in the pelvic parameters, except for the sacral slope in the group 1 for patients with a lumbar fracture. The current study confirms a greater correction in younger patients (Risser≤2) in spinal fractures and reported that thoracic fractures have a higher remodeling potential than lumbar fracture. A local kyphosis of almost 10° remained at the last follow-up. However, no deterioration in the sagittal plane balance was found. This suggests compensatory mechanisms in adjacent structures for children and adolescents and excludes the only hypothesis of bone remodeling.

Item Type:Article
HAL Id:hal-02310652
Audience (journal):International peer-reviewed journal
Uncontrolled Keywords:
Institution:Other partners > Centre Hospitalier Universitaire de Bordeaux - CHU (FRANCE)
Other partners > Assistance publique - Hôpitaux de Paris - AP-HP (FRANCE)
Other partners > Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE)
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Deposited By: Pascal SWIDER
Deposited On:15 Apr 2019 15:07

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