Purpose

Spinal thoracolumbar fractures represent 10-14% of pediatric fractures. Most children concerned by such fractures are above 10 years of age. No guidelines presently exist. Analysis of spine pathophysiology and of the various common therapeutic attitudes led us to conduct a review of the different therapeutic approaches in pediatric thoracolumbar fracture.

Methods

A review of the literature was carried out using the Medline and Embase databases with the search-term “pediatric thoracic lumbar spine fractures”.

Results

The systematic review identified 44 studies, 24 of which were selected, and 19 were included for analysis. Physiological age was categorized on Risser's classification. In Risser 1 with Magerl A1 fracture, surgical treatment was not necessary and functional (rest and analgesics) or conservative treatment (bracing for 6 weeks) was sufficient. In Risser 1 with Magerl A2, A3 or B fracture, conservative treatment (bracing for 3 months) was the first-line option. In Risser 2–4, conservative treatment with bracing for 3 months was possible in the absence of instability, with kyphosis > 20° and canal compression > 33%; otherwise, treatment should be surgical. Subsequently, in case of onset of secondary instability, surgical treatment can be proposed. We highlight the importance of MRI assessment for diagnosis of thoracolumbar fracture and associated lesions of the intervertebral discs and posterior ligament complex. Children classified as Risser 5 can undergo the same treatment as adults.

Conclusion

Two main parameters should be assessed in treatment decision-making for thoracolumbar fracture: the Risser scale and the Magerl classification.

中文翻译：

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儿童胸腰椎骨折：保守治疗还是手术治疗？

目的

脊柱胸腰椎骨折占小儿骨折的 10-14%。大多数与此类骨折有关的儿童都在 10 岁以上。目前没有指导方针。对脊柱病理生理学和各种常见治疗态度的分析使我们对小儿胸腰椎骨折的不同治疗方法进行了回顾。

方法

使用 Medline 和 Embase 数据库对文献进行了回顾，搜索词为“小儿胸腰椎骨折”。

结果

系统评价确定了 44 项研究，其中 24 项被选中，19 项被纳入分析。生理年龄按 Risser 分类。在患有 Magerl A1 骨折的 Risser 1 中，不需要手术治疗，功能性（休息和镇痛剂）或保守治疗（支撑 6 周）就足够了。在带有 Magerl A2、A3 或 B 骨折的 Risser 1 中，保守治疗（支撑 3 个月）是一线选择。在 Risser 2-4 中，在没有不稳定性、脊柱后凸 >  20° 和根管受压 >的情况下，可以进行 3 个月的支具保守治疗 33%；否则，应手术治疗。随后，如果发生继发性不稳定，可以建议进行手术治疗。我们强调 MRI 评估对诊断胸腰椎骨折及椎间盘和后韧带复合体相关病变的重要性。被列为 Risser 5 的儿童可以接受与成人相同的治疗。

结论

在制定胸腰椎骨折的治疗决策时应评估两个主要参数：Risser 量表和 Magerl 分类。