In this section
Fractures of the thoracic spine account for 25-30% of all spine injury in children, while lumbar fractures account for 20-25%.
Injuries to the thoracic spine and the thoracolumbar junction have a higher incidence of spinal cord injury, with neurologic deficit seen in up to 40% of cases.
Multiple-level injuries are seen in 30-40% of children with thoracic or lumbar spine fractures.
Fractures of the lower thoracic and upper lumbar spine have associated small bowel and visceral injury in up to 50% of cases.
Road traffic accidents and falls account for most of the injuries, but non-accidental injuries to these regions do occur.
Over the three-year period from July 1, 2000 through June 30, 2003, 89 thoraco-lumbar spine injuries were recorded in 57 patients at the RCH. A breakdown of these admissions by injury cause is given in Fig 1, while a breakdown of injuries sustained is
presented in Table 1.
Fig 1. RCH thoraco-lumbar spine injury admissions by mechanism, 20002003 (n=57)
Table 1. Thoraco-lumbar spine injuries by injury type
47% of patients with thoraco-lumbar spine injuries had an injury to one or more other body regions. A significant number of these (10 of 27 patients) had an abdominal injury with or without further injuries, usually as seat-belt injury in a motor vehicle
In all aspects of trauma
management, the primary survey is the first
Airway with c-spine stabilisation (see chapter 1.3) Breathing (see chapter 1.4) Circulation (see chapter 1.5)
Assessment of the spine should
take place in the secondary survey after the airway, breathing and
circulation have been assessed and stabilised.
Should focus on:
This is assessed by log-rolling the patient while spinal immobilisation is still in place.
Any patient who has pain or tenderness over the spine
should have the spine evaluated by radiography.
Patients at risk of having thoracic or lumbar spine (and
cervical spine) injuries missed:
As multi-level injuries are common, any child with a proven cervical spine fracture or spinal cord injury should have the entire spine imaged with plain radiographs.
Radiographs should be taken on any child who is at risk of having a thoracic or lumbar spine injury after clinical evaluation.
The standard views for both areas are:
While most thoracic and lumbar spine fractures are diagnosed on initial plain radiographs, these films often do not provide enough information on the extent of the injury and a CT scan of the region is usually obtained to elucidate the full extent of the injury. MRI
will be needed to visualise all ligament and spinal cord involvement.
Consultation with a paediatric orthopaedic surgeon or neurosurgeon should be sought for the definitive care of the injury.