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Pediatric Noncontiguous Spinal Injuries: The 15-Year Experience at 1 Pediatric Trauma Center

Firth, Gregory B. MBBCh, FCS (Orth); Kingwell, Stephen P. MD, FRCSC; Moroz, Paul J. MD, MSc, FRCSC

doi: 10.1097/BRS.0b013e31824079ea
Clinical Case Series

Study Design. Retrospective review.

Objective. To determine the incidence and clinical characteristics of noncontiguous spinal injuries (NCSI) in a pediatric population. The secondary objective is to identify high-risk patients requiring further imaging to rule out NCSI.

Summary of Background Data. NCSI can add significant complexity to the diagnosis, management, and outcome of children. There is very little in the pediatric literature examining the nature, associated risk factors, management, and outcomes of NCSI.

Methods. All children up to 18 years of age with a spinal injury, as defined by International Classification of Diseases, Ninth Revision codes, at one pediatric trauma hospital were included (n = 211). Data for patient demographics, mechanism of injury, spinal levels involved, extent of neurological injury and recovery, associated injuries, medical complications, treatment, and outcome were recorded.

Results. Twenty-five (11.8%) of 211 patients had NCSI, with a median age of 13.0 years (interquartile range = 8–15). The most common pattern of injury was a double thoracic noncontiguous injury. Sixteen percent of the cases of NCSI were initially missed, with no clinical deterioration due to missed diagnosis. Associated injuries occurred in 44% of patients with NCSI. Twenty-four percent of patients with multiple NCSI had a neurological injury compared with 9.7% in patients with single-level or contiguous injuries (P = 0.046).

Conclusion. There is a high incidence of children with multiple NCSI who are more likely to experience neurological injuries compared with patients with single-level or contiguous spinal injuries. Patients with a single-level spinal injury on existing imaging with an associated neurological injury should undergo at least plain films of the entire spine to exclude noncontiguous injuries. In patients without neurological injury and a single spinal fracture, radiography showing at least 4 levels above and below the fracture should be performed. All children with spinal injury should have associated injuries carefully excluded.

Retrospective review from 1 center of noncontiguous spinal injuries (NCSI) in children identifying risk factors for this injury and possible screening procedures. The incidence of NCSI was 11.8%, with 16% delayed diagnosis and thoracic spine most commonly injured. Neurological and other associated injuries were common.

From the Department of Surgery, Division of Pediatric Orthopaedic Surgery, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Address correspondence and reprint requests to Paul Moroz, MD, MSc, FRCS (C), Department of Surgery, Division of Pediatric Orthopaedic Surgery, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H8L1, Canada; E-mail:

Acknowledgment date: February 17, 2011. First revision date: October 12, 2011. Second revision date: November 1, 2011. Acceptance date: November 1, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional funds were received to support this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.