Paediatric spinal trauma: patterns of injury, clinical assessment and principles of treatment

Spinal fractures in children are almost always due to severe trauma as the result of road traffic accidents, significant falls, sporting activities or child abuse. This type of injury is most prevalent in the age groups of 5 years and younger or 10 years and older. Of all spinal fractures in children, 26-75% occur in the thoracic or lumbar region. 20% of children with a spinal fracture will have associated neurological compromise. Due to greater soft-tissue elasticity and the unique potential for bone remodelling during growth, injuries that occur in the paediatric spine present as different patterns compared to those in the adult population with certain injuries being unique to children. Such injuries exclusive to children are: a) spinal cord injury without radiographic abnormalities (SCIWORA), b) slipped vertebral apophysis, and c) spinal trauma in child abuse.