Anterior Cervical Discectomy and Fusion (ACDF) surgery is a highly effective procedure for treating various conditions affecting the cervical spine, such as herniated discs, cervical radiculopathy, and spinal stenosis. While ACDF can provide significant relief…
Paediatric thoracolumbar spine injuries are infrequent, and comprehensive epidemiological data are insufficient. This study aimed to provide such data for paediatric patients with thoracolumbar spinal trauma in Germany, with a focus on improving diagnostic and treatment decisions.
A retrospective multicentre study was conducted, involving patients aged up to 16 years who sustained thoracolumbar spine injuries and were treated at six German spine centres from January 2010 to December 2016. The clinical database was analyzed for patient characteristics, trauma mechanisms, injury levels, accompanying injuries, diagnostic imaging, and treatments administered. Patients were categorized into three age groups: Group I (0-6 years), Group II (7-9 years), and Group III (10-16 years).
A total of 153 children with 345 thoracolumbar spine injuries met the inclusion criteria. The average age at hospitalization due to injury was 12.9 years. The male-to-female ratio was 1.3:1, indicating a higher prevalence among boys. Falls and traffic accidents were identified as the primary causes of thoracolumbar spine injuries across all age groups. Of the patients, 95 (62.1%) received conservative treatment, while 58 (37.9%) underwent surgical intervention, with minimally invasive techniques being the most frequently utilized. The data also indicated that older children and adolescents were more likely to experience higher-grade injuries per the AOSpine classification. Injuries predominantly affected the thoracolumbar junction (T11 to L2), with 90 cases documented. Neurological deficits were rare across all age groups, while accompanying extremity injuries and head injuries were the most prevalent, each observed in approximately 30% of the patient cohort. During hospitalization, 96.7% of patients exhibited no complications related to their spinal injuries.
Injuries in older children and adolescents were more frequently severe. Although the majority of thoracolumbar spinal column injuries were managed conservatively, 37.9% of hospitalized children required surgical intervention, which was associated with an acceptable complication rate.
Thoracic and lumbar spine injuries constitute approximately 20-40% of all paediatric spinal injuries. The leading mechanisms contributing to these injuries in younger children include falls from significant heights and accidents during activities such as cycling and sports. Notably, thoracolumbar junction fractures have an incidence of 0.6 to 0.9%, often seen in children aged 14-16 years, predominantly males. The analysis of injury incidence among young patients reveals significant regional variances, thus making the transfer of epidemiological data between regions, including to Germany, problematic.
The retrospective multicentre study was conducted by the paediatric spinal trauma working group under the German Association of Orthopedic and Trauma Surgeons (DGOU). It involved all paediatric patients up to 16 years old with diagnosed thoracic and/or lumbar spine injuries across six level I spine centres throughout Germany. Only patients with comprehensive diagnostic workflows—particularly involving spinal injury classifications—were included in the analysis. Key patient data, injury circumstances, and treatment modalities were extensively documented.
The study recorded 172 concomitant injuries, with head and extremity injuries being the most common forms. The overall breakdown showed 256 injuries located within the thoracic spine, and 89 injuries occurring in the lumbar spine. Paediatric patients exhibited higher susceptibility to thoracolumbar junction injuries. The majority of fractures were classified as type A according to the AOSpine classification system, with endplate fractures being the most prevalent. Neurological impairments were associated more frequently with thoracic injuries than with lumbar spine injuries.
Of the participating cohort, 95 patients were conservatively treated, requiring surgical intervention in 58 children. Surgical techniques varied, efficiently addressing stability and alignment while catering to individual patient needs. The mean hospital stay for the cohort was 14.2 days, with various factors such as age, injury location, and severity correlating significantly to longer hospital stays. A very low complication rate was noted, with only a small percentage experiencing surgical-related issues.
In summary, paediatric spine injuries can greatly influence patient outcomes and management decisions. The rarity of such injuries complicates the diagnostic process, highlighting the importance of thorough examinations and appropriate imaging techniques. The current multicentre study presents the largest cohort of paediatric spine injuries in the German-speaking context, establishing a crucial foundation for future research and standardized treatment protocols. While most injuries were conservatively managed, surgical interventions were necessary for a significant portion, reflecting the complexities inherent in treating paediatric spine trauma.