Department of Neuroradiology, Hospital Dona Estefânia e São José, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal
- Publicação sob forma de poster electrónico no 44th ESNR Annual Meeting, 29 setembro a 3 outubro de 2021, Geneva, Switzerland
- Neuroradiology 2021 Sep; 63(Suppl 1): 1-93. doi: 10.1007/s00234-021-02791-y
Introduction: Although frequently related to osteoporosis, other pathological conditions and high-energy trauma can also lead to vertebral compression fractures (VCF). Traumatic VCF usually result from axial loading mechanisms, with traffic-related incidents and falls being the most common causes. We describe an illustrating case of a child and an adult exposed to the same traumatic spinal axial load yet showing different patterns of injuries.
Case Report: A 7-year-old male and his father were admitted to the emergency department after falling from a height of 6 meters inside their vehicle in a car elevator. The child presented with cervicothoracic spinal tenderness, and his neurological assessment was normal. Initial CT and additional MRI scans demonstrated VCF affecting T3-T11 and L3-L4 (anterior vertebral body wedging of T4-T9, particularly at T5 and T6), without the involvement of the posterior vertebral body wall. An accompanying non-compressive posterior acute epidural hematoma from T1-T9 was completely reabsorbed on follow-up MRI scan, performed eleven days later. Since therewere no instability or neurological deficits, a thoracolumbar orthosis was recommended for 6 weeks in a conservative approach. The 56-year-old male experienced pain referred to the thoracic and abdominal regions, without neurovascular compromise on physical examination. Whole spine CT scan showed burst fractures of L2 and L5 with retropulsed fragments causing spinal canal stenosis. He was subsequently submitted to surgical L1-S1 arthrodesis and bilateral decompressive laminectomy of L2, with clinical improvement. Initial CT also found simple VCF of T11, T12, L3, and L4, and fractures of the neural arch of L2, which were managed conservatively.
Discussion & Conclusion: Anatomy and biomechanics of the spine change as it matures, which determines particular age-dependent features of vertebral fractures. The unique circumstances of this case highlight that the same mechanism of injury acting simultaneously on two individuals of different age groups produces specific patterns of spinal involvement. In children, thoracolumbar traumatic fractures tend to affect more vertebrae and occur in higher thoracic levels, but the somatic deformity is usually less prominent than in adults, as shown.
Keywords: pediatric, spine, trauma, vertebral fractures