title: Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases.
abstract: OBJECTIVE
  The authors evaluated the mechanisms and patterns of thoracic, lumbar, and sacral spinal injuries in a pediatric population as well as factors affecting the management and outcome of these injuries.
  
  
  METHODS
  The records of 89 patients (46 boys and 43 girls; mean age 13.2 years, range 3-16 years) with thoracic, lumbar, or sacral injuries were reviewed. Motor vehicle accidents were the most common cause of injury. Eighty-two patients (92.1%) were between 10 and 16 years old, and seven (7.9%) were between 3 and 9 years old. Patient injuries included fracture (91%), fracture and dislocation (6.7%), dislocation (1.1%), and ligamentous injury (1.1%). The L2-5 region was the most common injury site (29.8%) and the sacrum the least common injury site (5%). At the time of presentation 85.4% of the patients were neurologically intact, 4.5% had incomplete injuries, and 10.1% had complete injuries. Twenty-six percent of patients underwent surgery for their injuries whereas 76% received nonsurgical treatment. In patients treated surgically, an anterior approach was used in six patients (6.7%), a posterior approach in 16 (18%), and a combined approach in one (1.1%). Postoperatively, six patients (26.1%) with neurological deficits improved, one of whom recovered fully from an initially complete injury.
  
  
  CONCLUSIONS
  Thoracic and lumbar spine injuries were most common in children older than 9 years. Multilevel injuries were common and warranted imaging evaluation of the entire spinal column. Most patients were treated conservatively. The prognosis for neurological recovery is related to the initial severity of the neurological injuries. Some pediatric patients with devastating spinal cord injuries can recover substantial neurological function.
authors.affiliation: Department of Neurosurgery, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Seref
authors.initials: S
authors.lastname: Dogan
authors.forename: Sam
authors.initials: S
authors.lastname: Safavi-Abbasi
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
authors.forename: Steven W
authors.initials: SW
authors.lastname: Chang
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horn
authors.forename: Nittin R
authors.initials: NR
authors.lastname: Mariwalla
authors.forename: Harold L
authors.initials: HL
authors.lastname: Rekate
authors.forename: Volker K H
authors.initials: VK
authors.lastname: Sonntag
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000453:epidemiology; D008022:Ligaments / Q000293:injuries; D008159:Lumbar Vertebrae / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures; D011379:Prognosis; D012447:Sacrum / Q000293:injuries*; D016103:Spinal Fractures / Q000453:epidemiology / Q000628:therapy; D013124:Spinal Injuries / Q000150:complications / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome