PAPER 046: CLINICAL FEATURES OF MULTIPLE NON-CONTIGUOUS SPINE FRACTURES IN CHILDREN

Abstract

Purpose: A single level spine fracture can be dangerous, however a second spine fracture at a different level can add complexity to patient management, and if missed, can result in a significant adverse outcome. Higher rates of multiple noncontiguous spinal injury (MNCSI) have been reported in patients who die from injuries, and with more unstable spinal injuries. The reported incidence in adults is 1.6–34%, but to our knowledge there are no studies examining multiple spine injuries in a pediatric population.

Method: A retrospective review of charts at an academic pediatric level 1 trauma center over a 15 year period identified a population with MNCSI.

Results: Twenty five (11.8%) out of 211 patients were identified with MNCSI and complete charts and radiographs. The mean age was 10.7 years old. MVC (motor vehicle collision) was the most common mechanism of injury for ages 0–9, while a fall was most common for ages 10–17 years. The mean number of vertebral levels injured was 3.2 and the most common region was the thoracic spine. Patients had a mean of 5.4 (range 1 to 22) intact vertebral levels between injuries. Twenty-four percent of patients with MNCSI had a neurologic deficit compared to 9.7% in patients with single level or contiguous injuries. This was statistically significant; risk ratio was 2.48 [1.09, 5.65]. Seven (78%) of 9 patients aged 0–9 suffered an associated injury; most commonly a visceral injury. The mortality rate was 8.0% in patients with MNCSI compared to 2.7% in patients with a single level injury.

Conclusion: We report a 12 % incidence of MNCSI in a pediatric trauma population. Children with NCSI were more likely to suffer neurologic injury than with a single level injury. Younger patients with MNCSI’s had a high rate of associated injuries. A higher mortality rate was seen in patients with MNCSI (not statistically significant). MNCSI’s can occur in conjunction with SCIWORA’s in the flexible pediatric spine. Clinicians must be aware of the incidence of NCSI’s in children, as well as their associations.