Tips for Managing Thoracolumbar Spine Injuries in Children – Chris Bonfield, M.D.
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.
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.
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
Conservative management: The main treatment of SCIWORA is external immobilization (12 weeks) with activity modification.(18, 19).