The relation of thoracic and lumbar fracture configuration to the development of late deformity in childhood spinal cord injury

STUDY DESIGN: A retrospective clinical observational study was conducted. OBJECTIVE: To assess the relation of spinal fracture type and its magnitude of distortion to subsequent long-term development of late spinal deformity in childhood onset spinal cord injury. SUMMARY OF BACKGROUND DATA: In this study, 76 adults who sustained spinal cord injury during childhood were examined clinically and radiographically alongside a retrospective review of case notes and radiographs. METHODS: The nature of the spinal injury and the progression of its displacement were defined from radiographs taken immediately after injury, then at 4 months and at 1 year. Eventual adult spinal deformity was defined from standardized erect long-plate radiographs. Scoliosis, kyphosis, and lordosis were measured using Cobb's method. RESULTS: There was no statistically significant difference in the severity of scoliosis, kyphosis, or lordosis between traumatic and nontraumatic injuries, nor between patients with and those without radiologically visible bony injury. Of the 14 patients with traumatic thoracic and lumbar injuries who had undergone no surgical intervention, 10 (71%) showed development of major scoliotic curves that did not include the fracture site. The patients with no angular displacement at the fracture site after 1 year went on to experience the development of more severe scoliosis (mean, 66 degrees) than those who had displaced fractures (mean, 38 degrees). In five, a low kyphotic curve and a compensatory lordosis above it developed. CONCLUSIONS: There is no evidence that the bony injury to the vertebral column itself in the child with spinal cord injury influences the development of late scoliosis or lordosis, but it may influence any eventual kyphosis.