Bracing Versus Surgical Management of Traumatic Pediatric Thoracolumbar Fractures: Case Series and Institutional Experience

Introduction: Thoracolumbar (TL) fractures are uncommon in the pediatric population. There is no consensus on the appropriate management when encountered in children. Conservative and surgical techniques exist but the optimal modality remains to be elucidated. We review our case series of children managed conservatively and surgically.

Methods: A retrospective review of pediatric patients ( < 18 years old) undergoing management for TL fractures was performed. Identified patients fell into 1 of 3 groups: conservative, open surgical, or minimally invasive surgical (MIS) instrumentation. Details of the clinical course and radiographic findings were reviewed. Descriptive statistics between the 3 groups were reported.

Results: 33 children met inclusion criteria. Most common inciting event was MVC. Fracture morphologies included chance, burst, 3-column, comminuted, and 1 “other” fracture.

12 patients, average age of 11.6, underwent MIS instrumentation. Chance fracture was the most treated injury. Average operative time, blood loss, length of stay, and follow up interval was 146 minutes, 52.8 mL, 8.3 days, and 9.67 months respectively. Intra-op fluoro and O-arm imaging was used and radiation exposure average was 1958 mGycm2.

15 patients, average age of 15.5, underwent management with brace alone. Burst fracture was the most treated injury and TLSO was the most used brace type. Average length of stay and follow up interval was 9.4 days and 4.5 months.

6 patients, average age of 15.2, underwent open PSF. 3 column injury was the most treated injury. Average operative time, blood loss, length of stay, and follow up interval was 125.33 minutes, 181.25 mL, 9 days, and 9 months respectively. Fluoro was only intra-op imaging used and radiation exposure average was 3193.98 mGycm2.

Two patients in the bracing only group had worsened alignment at follow up and 2 patients in the MIS instrumentation group suffered hardware issues intra-op and at follow up.

Conclusion : Bracing and short segment instrumentation are safe/effective treatments for pediatric patients. Neuro-navigation accuracy should be taken into stronger consideration likely secondary to lax soft tissues in very young children prior to using robotic assisted fixation. Further reporting of surgical treatments with comparison to age matched cohorts and long-term outcomes may help determine the most optimal management course.