Pathology of Thoracolumbar Spine Trauma in Children

Pathophysiology

Age-dependent differences

  • Pediatric vs. adult: There are significant anatomic differences between the pediatric and adult spine that must be considered in diagnosis and treatment.
  • Child’s physiology leads to more cervical spine injuries: In children, there is greater ligamentous flexibility and elasticity, shallower and more horizontal facets, relative paraspinal muscle immaturity, wedge-shaped immature vertebral bodies, natural kyphosis, and incomplete vertebral ossification. This leads to a greater prevalence of cervical spine injuries in young children compared with teenagers. By 8–10 years of age, the spine is similar to that of an adult (9,33).

Fracture-dependent Features

Variations in the direction of force loading on the spine, the amount of energy delivered to the spine and the location on the spine experiencing the force result in characteristic type of fractures.  These aspects are discussed in the linked child page discussing the Pathophysiological Features of the Subtypes of Thoracolumbar Spine Injuries in Children.