title: Conservative treatment of pediatric thoracic and lumbar spinal fractures: outcomes in the sagittal plane.
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.
authors.affiliation: Departments of aPediatric Orthopaedics bAdult Orthopaedics, Pellegrin University Hospital, Bordeaux cDepartment of Pediatric Orthopaedics, Robert Debré Hospital, ap-hp, Paris dDepartment of Pediatric Orthopaedics, Purpan University Hospital, Toulouse, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Angelliaume
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Simon
authors.forename: Louis
authors.initials: L
authors.lastname: Boissière
authors.forename: Aurore
authors.initials: A
authors.lastname: Bouty
authors.forename: Jérôme
authors.initials: J
authors.lastname: Sales de Gauzy
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Vital
authors.forename: Olivier
authors.initials: O
authors.lastname: Gille
authors.forename: Clément
authors.initials: C
authors.lastname: Tournier
authors.forename: Stéphane
authors.initials: S
authors.lastname: Aunoble
authors.forename: Jean-Roger
authors.initials: JR
authors.lastname: Pontailler
authors.forename: Yan
authors.initials: Y
authors.lastname: Lefèvre
mesh_terms: D000293:Adolescent; D001416:Back Pain / Q000628:therapy*; D016723:Bone Remodeling; D002648:Child; D000072700:Conservative Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis; D008159:Lumbar Vertebrae / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000473:pathology*; D016896:Treatment Outcome