title: Multiple level injuries in pediatric spinal trauma.
abstract: BACKGROUND
  The incidence of concomitant, particularly noncontiguous, spine injuries in the pediatric population has not been well described. There is a balance between limiting radiation exposure and not missing concomitant injuries; understanding of this risk of concomitant spine injuries in this population is important. We hypothesize that the rate of concomitant spinal injuries in children is similar to adults.
  
  
  METHODS
  The trauma registry of a pediatric trauma center was queried for all patients who sustained spine injuries over a 10-year period. Patient demographics, presence of other injuries, treatment, location and nature of the spine injury, as well as presence of multiple level injuries were determined.
  
  
  RESULTS
  One hundred and ninety-five patients with spine injuries were noted. Patients over age 8 years accounted for 76% of spine injuries (148 of 195). Concomitant injuries to other levels in the spine occurred in 32% of the patients (62 of 195); 6% of these secondary injuries were noncontiguous and were at least three levels away from the primary injury. All of the concomitant injuries were either in the thoracic or in the upper lumbar spine. Neurovascular status and mechanism of injury were not different between patients sustaining concomitant injuries or not.
  
  
  CONCLUSIONS
  Pediatric spine injuries are more common in patients over age 8 years of age; these patients are more likely to have multiple levels of injury. Of patients sustaining a spine injury, 6% had noncontiguous second fractures, which is a rate similar to adults. Imaging studies evaluating patients with spinal injuries should include at least three levels above and below the primary level of injury as well as the entire thoracic spine and thoracolumbar junction.
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, Massachusetts 02115, USA. susan.mahan@childrens.harvard.edu
authors.forename: Susan T
authors.initials: ST
authors.lastname: Mahan
authors.forename: David P
authors.initials: DP
authors.lastname: Mooney
authors.forename: Lawrence I
authors.initials: LI
authors.lastname: Karlin
authors.forename: M Timothy
authors.initials: MT
authors.lastname: Hresko
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013124:Spinal Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy