Tips for Managing Thoracolumbar Spine Injuries in Children – Chris Bonfield, M.D.

Compression fracture

  • Stable: Compression fractures are rarely unstable.
  • Little need for surgery: Most of these injuries do not need surgical intervention.
  • Activity modification: Activity modification with or without bracing (6–8 weeks) is management of choice for stable fractures.

Burst fracture

  • Stable fractures: Stable burst fractures without neurologic deficit can be managed with activity modification with or without bracing (8–12 weeks).
  • Unstable fractures: Burst fractures can be unstable with focal kyphosis, neurologic injury, lamina fracture, and facet subluxation. Unstable burst fractures are commonly treated with posterior instrumentation with fusion and decompression.
  • Retropulsion: Anterior or lateral corpectomy, followed by posterior instrumentation, may be utilized in patients with significant retropulsion.

Flexion-distraction (Chance fracture)

  • Conservative management: Purely bony fracture with good and maintained reduction (supine and standing) could be managed in TLSO brace or casting (8–12 weeks).
  • However, most require surgical treatment: This is generally achieved with posterior instrumentation and fusion.

Fracture-dislocation

  • Unstable: This injury pattern is inherently unstable.
  • Surgical technique: Decompression and stabilization with instrumentation and fusion is generally performed for treatment.

Apophyseal fracture and herniation

  • Conservative management: Anti-inflammatory medication with or without bracing (8 weeks) is the initial treatment in patients without neurologic deficit.
  • Surgical decompression: Patients with failure of conservative management or neurologic deficit may require surgical decompression with or without removal of herniation.

Spinous process/transverse process fracture

  • Conservative management: Conservative treatment with pain control and initial activity medication is the treatment.
  • These fractures do not require surgical intervention

SCIWORA

  • Conservative management: The main treatment of SCIWORA is external immobilization (12 weeks) with activity modification.(18, 19).