A modeling capacity of vertebral fractures exists during growth: an up-to-47-year follow-up.

STUDY

DESIGN

The study is an observational cohort study.

OBJECTIVES

To determine the incidence and the long-term outcome of thoracic or lumbar vertebral fractures in children.

SUMMARY OF BACKGROUND DATA: The incidence of vertebral fractures in children is described as rare and the outcome as favorable. However, no studies evaluate the clinical and radiographic long-term outcome and if a fractured vertebra could be rebuilt during growth.

METHOD: The incidence of vertebral fractures in children was evaluated through the radiographic archives. Twelve boys and 12 girls, aged 7-16 when sustaining the fracture, 21 one-column compression fractures and 3 burst fractures Denis type B, all without neurologic deficits, attended the follow-up. Primary treatment consisted of immediate mobilization without brace. Clinical and radiographic examinations were performed 27-47 years after the injury.

RESULTS

The annual incidence of thoracic and lumbar vertebral body fractures in individuals below age 16 was 0.07%. Twenty-one individuals had, at follow-up, no subjective complaints, 3 had occasional back pain (Oswestry Scores 8, 22, and 26), 23 were classified as Frankel E, and 1 as Frankel D. The radiographic ratio anterior height/posterior height of the fractured vertebral body increased from 0.75 after injury to 0.87 at follow-up (P < 0.001). The posttraumatic kyphosis in the fractured region decreased in 8 individuals (33%), all aged 13 or less at fracture. No increased disc degeneration was observed.

CONCLUSION

Thoracolumbar vertebral fractures without neurologic deficits, sustained during growth, have a favorable long-term outcome. A modeling capacity, reducing the fracture deformity, exists at least in the youngest patients.