Management of Thoracolumbar Spine Trauma in Children

Initial Management at Presentation

  • Considerations for treatment: Treatment plans must consider the stability of the injury, the need for decompression, and the long-term potential for healing.
  • TLICS scoring: The Thoracolumbar Injury Classification and Severity Score is recommended to be used for guidance regarding stability and the need for surgical intervention (including fracture morphology, neurologic involvement, and posterior ligamentous complex integrity). This has been validated in the pediatric population (10,32,35,36).
  • Need for surgery: Overall, between 4 and 30% of pediatric spine injuries require operative treatment (31,33).

Adjunctive Therapies

  • Mobilization and physical therapy: After surgical repair and stabilization, the patients is mobilized with increasing activity.

Follow-up

  • Follow for 2 years if surgery required: Specific postoperative follow-up schedules vary. However, office visits with x-ray imaging generally occurs at 2–3 months, 4–6 months, 1 year, and 2 years after surgery.
  • Other imaging:  If there is concern for complications, such as change in neurologic symptoms, infection, loosening of hardware, etc., other imaging modalities, such as CAT scan or MRI should be considered.