Long-Term Outcome of Fractures of the Thoracic and Lumbar Spine

Sammanfattning: From the radiographic archives at the Malmö University Hospital, Malmö, Sweden, we identified children below age 16 years (n=74) and adolescents between 16 to 18 years (n=40) with a clinically and radiographically diagnosed thoracic or lumbar vertebral fracture between 1950 to 1971 (with exception of two years of missing radiographs), and all adults above age 18 years (n=39) with a non-operatively treated thoracic or lumbar burst fracture during the years 1965 to 1973. Fractures were classified according to Denis. The annual incidence of thoracic and lumbar vertebral fractures in children was 0.07? (I), and in adolescents 0.14? (II). Twenty-four children (I) and 23 adolescents (II) attended a follow-up 27 to 47 years after the injury and 27 adults (III), 23 to 41 years after the injury. All had been non-operatively treated. Clinical outcome was evaluated by the Oswestry score and the Frankel scale, and radiographical outcome by plain spine radiographs. In addition, the outcome of the discs in 20 of those with a fracture before age 16 years (IV) were evaluated by MRI, and the Oner classification, 33 to 53 years after the injury. Twenty-one children (I) were classified with a compression fracture and 3 with a burst fracture Denis B. All were classified as Frankel E. At follow-up, twenty-one reported no back pain, and 3 occasional back pain. Twenty-four were classified as Frankel E, and 1 as Frankel D. Fourteen adolescents (II) were classified with a compression fracture and 1 with a burst fracture Denis A, six with a Denis B, one with a Denis D and one with a Chance fracture. Twenty-one were classified as Frankel E, two as Frankel D. At follow-up, eighteen reported no back pain and 5 occasional back pain. Twenty were classified as Frankel E and 3 as Frankel D. Four adults (III) were classified with a burst fracture Denis A, eighteen with a Denis B, one with a Denis C and 4 with a Denis E (III). Twenty were classified as Frankel E and seven as Frankel D. At follow-up, 12 reported no back pain, 9 minimal back pain, 3 moderate back pain, and 3 severe back pain. Twenty-one were classified as Frankel E and 6 as Frankel E. During the follow-up period, the wedge shape of the fractured vertebral body decreased in the children (I), remained unchanged in the adolescents (II) and increased in the adults (III), indicating that a fractured vertebral body can restore the height if a substantial growth potential remains. During the same period, the adjacent disc heights were maintained in all age groups (I, II, III). In the children, evaluated by MRI (IV), there were no more degenerative changes at the disc levels adjacent to the fracture than could be expected by age. In contrast, there were more Schmorl's nodes at the same segments.