Language
English
Publication Date
8-1-2023
Journal
Journal of the Pediatric Orthopaedic Society of North America
DOI
10.55275/JPOSNA-2023-697
PMID
40433341
PMCID
PMC12088191
PubMedCentral® Posted Date
2-12-2024
PubMedCentral® Full Text Version
Post-print
Abstract
Background: Compression fractures are often associated with lower energy trauma and may occur in the setting of abnormal bone health associated with genetic disorders and endocrine disorders, neoplastic disease, infection, and inflammatory disorders. There is no significant series in the literature describing the prevalence or etiology of pathologic pediatric compression fractures.
Methods: IRB-approved retrospective study was performed at a tertiary children's hospital from 2012-2022. Patients < 18 years old diagnosed with atraumatic vertebral compression fractures were included and reviewed for demographics, underlying diagnosis/comorbidity, presentation, mobility, deformities, imaging data, treatments, and outcomes.
Results: 181 patients (54% Male) were included with mean age 14.17 years and follow-up of 20 months. A compression fracture was the presenting symptom of an underlying diagnosis in 32% of patients, and 21% of patients received an MRI to distinguish between metastatic disease and benign fractures. Primary osteoporosis was the cause in 15% and secondary osteoporosis was in 65% of patients; most commonly due to immunosuppressants (46%) and acute lymphoblastic leukemia (ALL) (10%). Primary lesions were the etiology in 20% of patients. There was a median of 3 fractures per patient, mostly of the midthoracic (82%) and thoracolumbar spine (51%). Radiographs revealed wedge fractures in 82%, biconcave fractures in 22%, and vertebra plana in 12%. Patients were managed with observation (46%), bracing (31%), bisphosphonates (31%), and fusions (4%). By last follow-up, there was a higher proportion of patients who developed scoliosis or became wheelchair-bound. Overall, there was a 16% mortality rate which was mostly associated with cancer.
Conclusion: Overall, 32% of patients presented with a compression fracture as the presenting symptom of an underlying disease. Pathologic vertebral compression fractures in children frequently occurred due to immunosuppressants, ALL, and metastatic disease. The fractures were most often wedge morphology in the thoracolumbar and mid-thoracic regions of the spine. MRIs may be useful for distinguishing between benign fractures and malignancy.
Levels of Evidence: Level IV.
Published Open-Access
yes
Recommended Citation
Taylor, Tristen N; Bridges, Callie S; Pupa, Lauren E; et al., "Retrospective Review of 181 Patients with Pathologic Vertebral Compression Fractures" (2023). Faculty and Staff Publications. 5535.
https://digitalcommons.library.tmc.edu/baylor_docs/5535
Included in
Medical Sciences Commons, Musculoskeletal Diseases Commons, Orthopedics Commons, Surgery Commons