Abstract |
To assess sagittal plane spinopelvic balance and functional outcomes in a pediatric cohort of patients with a thoracic and/or a lumbar fracture treated conservatively. A multicentric study retrospectively reviewed radiological and functional outcomes (mean follow-up 49 months) of 48 patients (mean age 12 years) with thoracic and/or lumbar spinal fractures that occurred between 1996 and 2014. Demographic data and radiological spinopelvic parameters were analyzed. Functional outcome was evaluated by a telephone interview. First, a comparison between the initial and the last follow-up full-spine radiographs was performed for the assessment of bone remodeling and sagittal plane balance. Then, patients were classified into two groups (group 1: Risser≤2 and group 2, Risser>2) to assess the influence of skeletal maturity on the restoration of a correct sagittal balance. A total of 62% of the patients were at skeletal maturity at the final follow-up (Risser 4 and 5). Patients with a Risser grade of 2 or less had a higher remodeling potential. The mean residual local kyphosis in thoracic and lumbar fractures was, respectively, 8.2° and 8.7°. The mean thoracic global kyphosis remains stable at the last follow-up, in contrast to lumbar lordosis, which increased significantly. Sagittal plane global measurements on the basis of the C7-plumbline remained unchanged at the last follow-up. There was no change in the pelvic parameters, except for the sacral slope in the group 1 for patients with a lumbar fracture. The current study confirms a greater correction in younger patients (Risser≤2) in spinal fractures and reported that thoracic fractures have a higher remodeling potential than lumbar fracture. A local kyphosis of almost 10° remained at the last follow-up. However, no deterioration in the sagittal plane balance was found. This suggests compensatory mechanisms in adjacent structures for children and adolescents and excludes the only hypothesis of bone remodeling.
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Authors | Audrey Angelliaume, Anne-Laure Simon, Louis Boissière, Aurore Bouty, Jérôme Sales de Gauzy, Jean-Marc Vital, Olivier Gille, Clément Tournier, Stéphane Aunoble, Jean-Roger Pontailler, Yan Lefèvre |
Journal | Journal of pediatric orthopedics. Part B
(J Pediatr Orthop B)
Vol. 26
Issue 1
Pg. 73-79
(Jan 2017)
ISSN: 1473-5865 [Electronic] United States |
PMID | 27186905
(Publication Type: Journal Article, Multicenter Study)
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Topics |
- Adolescent
- Back Pain
(therapy)
- Bone Remodeling
- Child
- Conservative Treatment
- Female
- Follow-Up Studies
- Humans
- Kyphosis
(diagnosis)
- Lumbar Vertebrae
(pathology)
- Male
- Retrospective Studies
- Spinal Fractures
(therapy)
- Thoracic Vertebrae
(pathology)
- Treatment Outcome
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