Vertebral fractures in late adolescence: a 27 to 47-year follow-up

Abstract

The long-term outcome of thoracic and lumbar fractures in late adolescence is sparsely described and it is unclear whether a fractured vertebral body in these years, as in young children, can be resituated in height. The purpose of this study was to in late adolescence determine the incidence, the long-term outcome and the modelling capacity in fractures of the thoracic and lumbar region. The incidence of vertebral fractures 1950-1971 in individuals aged 16-18 years was through the radiological archives evaluated in a city cohort of 228,878 citizens, of whom 13,893 were aged 16-18. A follow-up, 27-47 years after the injury, including subjective, objective and radiological evaluation was conducted in 18 boys and 5 girls. Twenty-nine boys and 11 girls were registered with a thoracic or lumbar vertebral fracture during the study period conferring an annual incidence of 0.14 per thousand. Of the 23 individuals that attended the follow-up, 14 had one-column compression fractures, one a Denis type A, six a Denis type B, one a Denis type D and one a Chance fracture. At injury, one had a partial paresis in one leg and one developed a transient paraparesis during the first week. All were treated non-operatively. At follow-up, 18 individuals had no complaints while 5 had occasional back pain, 20 were classified as Frankel E and 3 as Frankel D. The radiographic ratio of anterior height to posterior height of the fractured vertebral body was unchanged during the study period. Thoracic and lumbar vertebral fractures in late adolescence with no or minor neurological deficits have a predominantly favourable long-term outcome, even if no modelling capacity of the fractured vertebral body remains in late adolescence.

Fig. 1

Method of measuring the degree of vertebral body compression of the fractured vertebra by calculating the ratio anterior height/posterior height on a lateral radiograph

Fig. 2

Method of measuring the degree of local kyphosis of the injured segment on a lateral radiograph

Fig. 3

Lateral radiograph of boy aged 18 showing fracture of vertebra Th12 and L1 a at the time of the fracture event b after 30 years