Flexion–distraction injuries of the spine: Features of diagnostics, clinical picture, and results of surgical treatment of children

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BACKGROUND: Flexion–distraction injuries of the spine result from high-energy trauma (traffic accidents and falls from a height). This type of injury is commonly found in the thoracolumbar junction. Among combined injuries in the presence of flexion–distraction fractures of the vertebral column, injuries of the chest or abdominal organs are often observed, which are crucial for patient survival, and their diagnostic measure is complex because of the severe and unstable conditions of the patients.

AIM: To analyze a cohort of pediatric patients who underwent surgery for flexion–distraction injury of the spine.

MATERIALS AND METHODS: We analyzed the data of clinical and instrumental studies and surgical outcomes of 28 pediatric patients (aged 2–17 years) with flexion–distraction injuries of the spine. The standard preoperative examination included clinical and laboratory studies, spondylography, multislice spiral computed tomography and magnetic resonance imaging of the damaged area, electrocardiography, and ultrasonography of the abdominal organs and kidneys. All patients underwent surgery for the correction and stabilization of traumatic spinal deformity with a multisupport metal structure and posterior local fusion. The analysis included an assessment of the mechanism of injury, concomitant injuries, time elapsed after the injury before admission to the hospital, level of the damaged segment, and treatment. Data were processed statistically using an online calculator. The nonparametric Mann–Whitney method was used.

RESULTS: Catatrauma was the leading cause of injury in 50% of the patients, compared with traffic accidents in 36%. In 80% of the patients, spinal injury was localized at the thoracolumbar junction and lumbar spine. Moreover, 71% of the patients were transferred to the National Research Center for Children’s Orthopedics and Trauma Surgery for surgical treatment on the spine in the early stages after injury (up to 7 days), and 8 children (19%) were admitted within 10–45 days (average 16 days). In 19 (68%) patients, in addition to spinal injury, concomitant injuries occurred, with skeletal trauma and injuries of the abdominal cavity organs as the most frequent. All patients achieved complete correction of the deformity at the level of the damaged segment.

CONCLUSIONS: Flexion–distraction fractures of the spine in children are characterized by a high incidence of concomitant injuries, which dictates the need for a full examination to identify them and correctly interpret the data. The elimination of mechanical instability in the early stages in this type of injury can reduce the extent of fixation and contribute to the restoration of the physiological profile and disk apparatus of the spinal column.

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作者简介

Aleksandra Filippova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: alexandrjonok@mail.ru
ORCID iD: 0000-0001-9586-0668
SPIN 代码: 2314-8794

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Dmitriy Kokushin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: partgerm@yandex.ru
ORCID iD: 0000-0002-2510-7213
SPIN 代码: 9071-4853

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Nikita Khusainov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: nikita_husainov@mail.ru
ORCID iD: 0000-0003-3036-3796
SPIN 代码: 8953-5229
Scopus 作者 ID: 57193274791
Researcher ID: AAM-4494-2020

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

参考

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  3. Arkader A, Warner W, Tolo V, et al. Pediatric chance fractures: a multicentre perspective. J Pediatr Orthop. 2011;31:741–744. doi: 10.1097/BPO.0b013e31822f1b0b
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  6. Henry DA, Bumpass DB, McCarthy RE. Delayed diagnosis of a flexion-distraction spinal injury and occult small bowel injury in a pediatric trauma patient: importance of recognizing the abdominal “seatbelt sign”. Trauma Case Rep. 2021;34. doi: 10.1016/j.tcr.2021.100499
  7. Andras LM, Skaggs KF, Badkoobehi H, et al. Chance fractures in the pediatric population are often misdiagnosed. J Pediatr Orthop. 2019;39(5):222–225. doi: 10.1097/BPO.0000000000000925
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  10. Schiedo RM, Lavelle W, Ordway NR, et al. Purely ligamentous flexion-distraction injury in a five-year-old child treated with surgical management. Cureus. 2017;9(4). doi: 10.7759/cureus.1130
  11. Krafft PR, Noureldine MHA, Jallo GI, et al. Percutaneous lumbar pedicle fixation in young children with flexion-distraction injury-case report and operative technique. Childs Nerv Syst. 2021;37(4):1363–1368. doi: 10.1007/s00381-020-04845-7

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1. JATS XML
2. Fig. 1. Diagram of the relationship between the cause of the injury and the associated injuries and neurological deficits resulting from the injury. CCCI, closed craniocerebral injury; OCCI, open craniocerebral injury; RTA, road traffic accident

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3. Fig. 2. Diagram of the distribution of concomitant injuries and neurological deficits resulting from injury with flexion-distraction spinal injury in pediatric patients injured in a road traffic accident. CCCI, closed craniocerebral injury

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4. Fig. 3. Radiographs and multislice computed tomogram of patient S., 7 years old, with a single-level transosseous injury (Chance fracture), before surgical treatment: (a) radiographs of the thoracic and lumbar spine in the frontal and lateral views in prone position; (b) sagittal section on a multislice computed tomogram of the lumbar spine

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5. Fig. 4. Radiographs and multislice computed tomogram of patient S., 7 years old, after surgical correction of kyphotic traumatic deformity: (a) radiographs of the thoracic and lumbar spine in the frontal and lateral views in the upright position; (b) sagittal section on a multislice computed tomogram of the lumbar spine

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6. Fig. 5. Radiographs and magnetic resonance imaging of patient S., 9 years old, 2 years after surgical treatment, after dismantling the surgical hardware: (a) radiographs of the thoracic and lumbar spine in the frontal and lateral views in the upright position; (b) frontal and sagittal sections on a magnetic resonance imaging scan of the lower thoracic and lumbar spine

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