Percutaneous screw instrumentation in the treatment of thoracic and lumbar fractures in children.

PURPOSE: Managing thoracolumbar fractures implies stabilization of the level involved and restoration of global sagittal balance. These objectives are especially challenging in children's growing spine, even more as they occur very rarely.

METHODS

We reviewed all cases of children aged under 18, operated in Lille University Hospital from 2005 to 2021. We included all children treated by percutaneous screw fixation for thoracic or lumbar vertebral fracture. Clinical data before and after surgery, surgical early and late course, sagittal balance were key elements to our study.

RESULTS

21 patients were included, mean age was 16 (13-18), 52% were male. In Aospine classification, our cohort was composed by A4 fractures (9 patients), A3 fractures (4 patients), A2 fractures (3 patients), B1 fracture (3 patients), B2 fractures (1 patient) and B3 fractures (1 patient). 14 patients had short-segment fixations. Surgical length was average 86 min, blood loss was meaningless (average 50 mL), hospital stay was average 9 days, because of association with other traumatic pathologies. No complication was recorded. VA score was always diminished after surgery and no chronic pain was recorded. For all patients, an improvement of vertebral kyphosis and sagittal balance was demonstrated. One year follow-up revealed no case of pseudoarthrosis, no late kyphosis, even after material removal.

CONCLUSION

Percutaneous screw fixation is a rapid, safe and relevant technique, that should always be considered first, while discussing surgery in children or adolescents for non neurologic thoracolumbar fracture.