Compression fracture of the spine in children: causes, symptoms and treatment. If there is a spinal fracture

The children's spine has a very flexible structure and is highly resistant to damage and various mechanical impacts. Therefore, modern traumatology rarely encounters spinal fractures in children. Mostly active teenagers aged 10-15 years receive such injuries.

Often, extreme physical activity, which is present in sufficient quantities in the life of any child, leads to spinal injuries. These could be:

falling, especially from a height;
diving into water;
sharp bending of the back during somersaults;
heaviness suddenly falling on the head and shoulders;
accident cases;
diseases of osteoporosis, osteomyelitis.

Any severe injury causes contraction of the flexor spinal muscles; an excessive load is applied to the vertebrae, many times higher than the limit of normal flexion, which leads to compression of the vertebrae. So, falling headfirst will cause damage to the cervical and thoracic vertebrae, and landing on the back, buttocks, or legs will damage the lumbar region.

How to recognize?

Typical symptoms of any fracture of the vertebral bones are local pain in the area of injury, swelling and bruising, signs of impairment motor functions limbs, pelvic organs, crepitus of fragments, visible deformities of the vertebrae. Symptoms may vary depending on the location of the injury:

Intense pain, which are localized in the area of the shoulder blades and gradually encircle the chest - these are clear symptoms of damage to the thoracic vertebrae. Post-traumatic apnea is noticeably pronounced - the child has difficulty breathing, for 1-3 minutes he cannot fully inhale or exhale. The skin of the face may take on a bluish tint. The child feels helpless and confused. Over time, breathing is restored and the pain dulls.
There is practically no holding of breath, but other symptoms appear - “false peritonitis” if the vertebrae of the lumbosacral region are injured. Abdominal muscles are tense short-term pain in the abdominal area is felt. Movements of the torso, head, and limbs result in sharp pain.
Tension and soreness posterior muscles neck characterizes a fracture of the cervical vertebrae. The child is forced to tilt his head, he is limited in his movements, if he tries to turn his head, the pain noticeably intensifies, deformation is noticeable.

In the case of a complicated spinal fracture, children may have disorders of urination, defecation, and motor functions hip joints. If pinched spinal cord, partial and sometimes complete paralysis of the arms and legs occurs. Symptoms of paresthesia and numbness also appear, the child feels “crawling goosebumps” on the skin, coldness or burning. Reflexes may be absent, decreased blood pressure, muscle pain arises.

Urgent Care

Information for curious parents:

As soon as you notice signs of a fracture, you should take immediate measures precautions.

Goal: eliminate pain shock and prevent displacement of damaged vertebrae.

The first action you must take is to call the trauma department, call ambulance or ensure that the child is transported to the hospital yourself.

Transport only on a flat, hard surface, a stretcher or a board covered with several blankets. When there is no solid base for transportation at hand, the victim is transported in supine position on the stomach. IN winter period Cover the child with a warm blanket.

If a fracture of the cervical vertebrae occurs, cover the child’s neck with a thick layer of cotton wool and bandage it. Do not try to straighten the position of your head, straighten the vertebrae yourself, and do not touch the damage at all!
If the thoracic vertebrae are injured, lay him on his back, and if the lumbar vertebrae are injured, lay him on his stomach, place additional bedding under his head.

Be sure to read:

Do not allow a child with a spinal injury to move, turn, or even sit down independently. The slightest awkward movement will lead to displacement of the fragments. There is a danger of compression of the spinal cord.

Classification

More often you will encounter a common injury -. Depending on how deformed the vertebrae are, three degrees are distinguished:

Characterized by a reduction of the vertebra by ½ of its normal height;
Reducing the height of the vertebra by almost half;
The height of the vertebra has decreased by more than half.

Compression fractures are also classified according to complications:

Uncomplicated type has a hidden form, accompanied only by pain of moderate intensity. Sometimes the symptoms are completely ignored due to ignorance that such damage provokes radiculitis and osteochondrosis.
Complicated type It’s hard not to notice, because in addition to pain, there are symptoms of neurological disorders. This type of fracture is very dangerous. Bone fragments formed at the time of injury can damage nerve roots. The child's limbs may lose sensation and a feeling of numbness may appear. Injuries to the thoracic vertebrae have serious consequences: kyphoscoliosis is formed, causing disturbances in the functioning of the heart and lungs.

Diagnostics

Pain is not a universal sign of a fracture; it can be the cause of many other pathologies. Therefore, only a pediatric traumatologist can make the correct diagnosis. He will study the circumstances of the injury, symptoms, examination data and prescribe a set of diagnostics to determine the most suitable method treatment. The complex includes:

Radiography, which is performed simultaneously in two projections, accurately determines the nature of the damage.
Computed tomography. Prescribed for a detailed study of the injured spine. At the same time, myelography can be performed to study the condition of the spinal cord.
Magnetic resonance therapy carried out if the traumatologist has identified signs of nerve damage.
Neurological examination is prescribed to check whether the spinal cord and peripheral nerves are functioning correctly.
Densitometry helps determine if a child has osteoporosis.

Treatment methods

If the fracture is uncomplicated, functional treatment will be prescribed.

Goal: to relieve the back, protect the vertebrae from further deformation, protect the spinal cord from compression. To do this, traction of the spine by the armpits is performed using Delbe rings or a Glisson loop behind the head. Also, cushions are placed under the neck and lower back to reclinate the vertebrae.

If a complicated fracture occurs, surgical treatment is inevitable.

Goal: sequential resection of the vertebra that puts pressure on the spinal cord and nerve roots. Then the damaged area is fixed with special titanium plates. Most modern methods Vertebral decompressions are kyphoplasty and vertebroplasty.

Kyphoplasty– aimed at restoring normal vertebral height. The essence of the operation is to insert a special balloon into the vertebral bones. By inflating, it restores its original height. Then bone cement is injected into the cavity formed by the balloon, which fixes the vertebra in its normal position.
Vertebroplasty– consists of introducing special acrylic cement with a biopsy needle. Cement fills the cavities between vertebral fragments and stabilizes them. Advantage this method in minor skin trauma and relatively quick elimination pain syndrome.

The main task is given to physical therapy. First, it is performed lying down, gradually adding axial load. Also, in the first days of treatment, breathing exercises, massage, physiotherapy in the form of UHF, ultraviolet radiation, diadynamic therapy and electrophoresis, paraffin and ozokerite applications are recommended.

Be sure to read:

The patient assumes a vertical position only with the help of a special reclining corset. The time spent in the corset is individual, depending on the severity of the injuries and the control X-ray images obtained.

The child will be allowed to make his first attempts to walk only after 2 months, to sit – after 4 months if there was an injury to the cervical or thoracic vertebrae and at least 8 months after an injury to the lumbar region.

Rehabilitation

Recommended reading:

Relieving pain

The stage lasts 3-5 days, during which time you need to relieve the damaged area of the spine and relieve pain. The doctor prescribes a strict bed rest, combined with spinal traction and the use of a reclining roller. The bed should be hard, the headboard raised 30 degrees.

Physiotherapy is prescribed in the form of electrophoresis with novocaine, exercise therapy - breathing and motor exercises, which improve metabolism, blood circulation, and lung function. The child performs all exercises lying down; raising the head and legs is strictly prohibited.

Normalization of blood circulation

The duration of the stage is 10-15 days. The doctor prescribes physical therapy, which will improve blood circulation in the area of injury. This may be a 15-day course of magnetic therapy, electrophoresis with aminophylline or nicotinic acid, and myostimulation procedures may also be included in the course.

When the pain disappears, a symmetrical massage will be prescribed, as well as 4-5 sessions per day of exercise therapy to form a muscle corset. The child should still lie in traction, but will be allowed to turn onto his stomach and lean on his elbows to perform the exercises. Over time, the number of turns will increase to 6-8 times a day, and total time Staying in this position will reach 1-1.5 hours.

Muscle rehabilitation

The stage lasts 7-10 days. The child continues to lie in bed in traction and receives physical therapy and stimulating massage. The entire course of treatment at this stage is aimed at restoring the muscle corset. From the 20th day of hospital stay, the child is prescribed physical therapy exercises on all fours. After another 5 days he is transferred to conservative treatment.

Important information:

The result of treatment is the complete recovery of the victim, but sometimes complications occur. The consequences of a fracture are manifested by pain and difficulties when the child tries to perform the simplest movements. The reason for this is instability of spinal segments, which can later develop into post-traumatic osteochondrosis, traumatic spondylitis, kyphosis or intervertebral hernia.

Prevention

Is it possible to protect a child from fractures and other injuries? It is possible, knowing the density of his bone tissue. Often, osteopenia is only discovered when a preventable fracture occurs. There is a procedure - densitometry, which is absolutely harmless to the health of children. After completing the study, you will receive complete information about the degree of bone density of the child, as well as the doctor’s recommendations regarding nutrition and physical activity. If osteoporosis is detected, the child will be prescribed additional diagnostics and based on the results, drug therapy.

Interesting read:

in order not to treat the consequences, try to protect the child from traumatic activities;
During periods of active growth, check bone density;
if osteoporosis is detected, remember that the bones of the spine are the most vulnerable;
a child whose bones have low density, active games on trampolines, visiting slides, somersaults, jumping from heights are contraindicated;
in the autumn-winter period, children need to be given vitamin D;
the diet should include foods containing calcium: cottage cheese, cheese, etc.;
It is better to exclude carbonated drinks;
Provide your child with healthy daily physical activity.

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Every parent experiences childhood injuries, but falls in children often resolve without complications. However, there are injuries that lead to severe consequences. These include compression fractures of the spine in children, which, if not treated correctly, can cause disability for life.

What is a compression fracture?

What is a vertebral compression fracture? Structure spinal column consists of vertebrae, muscles and ligaments, and its main function- protects the spinal cord. A compression fracture of the main part of the musculoskeletal system is caused by contraction, compression, deformation and cracking of the vertebrae. In this regard, they become wedge-shaped, and the apex, moving beyond its limits, can put pressure on the lower vertebra or stick into the spinal cord.

In children, vertebral body fractures of this type are rare and, for the most part, respond well to treatment. But this is only possible if the injury was detected in time and treatment was carried out competently. In the absence of therapy or its ineffectiveness, the consequences will be severe.

Treatment of compression fractures of the thoracic spine and its other areas must be carried out comprehensively and include, as traditional conservative methods, as well as exercise therapy, special massage for compression fractures of the spine and other rehabilitation methods.

Factors causing injury

Children under 8 years of age rarely suffer a spinal fracture. This is due to the fact that the child’s skeleton has not yet completely ossified - the spine is plastic, intervertebral discs higher. But despite this, even children can get this injury due to overload of the vertebrae.

The main factors of compression fracture:

as a result of a fall or accident;
during an unsuccessful dive;
sudden fall on the pelvis;
landing on your feet from a great height;
low amount of calcium in the body;
osteoporosis, osteomyelitis;
weakened back muscles;
falling of a heavy object on the head or shoulders;
increased load during sports activities, somersaults;
sudden lifting of weight;
tumor metastasis to the vertebrae;
congenital pathology of the musculoskeletal system;
birth injuries of the baby.

Quite often, a compression fracture is accompanied by injuries such as fractures of the pelvis, limbs, concussion of the brain or spinal cord, and other traumatic brain injuries.

Classification of injury

The first two places are occupied by injuries of the spine of the middle and lower thoracic region, the third place in popularity is assigned to the lumbar zone, followed by the upper thoracic and cervical. In addition, compression fractures of the spine in children are divided according to the type of vertebral deformation and the nature of complications.

IN international classification There are three degrees of damage:

I or stable – the damaged vertebra has sank by 1/3;
II or unstable – reduction in the height of the vertebral body by half;
III - the vertebra is deformed by more than 50%.

A fracture also occurs:

uncomplicated - pain only at the site of the injury;
complicated – there is a disruption of the spinal cord.

Severe injury with multiple injuries and the formation of bone fragments can cause disability. The consequences of a fracture of the cervical vertebrae are very severe, including death.

Symptoms

A compression fracture of the spine in a child is different in that it does not have pronounced symptoms. If the fracture is uncomplicated, then discomfort They pass quickly and may not manifest themselves for some time. Secondary signs of injury are nausea, dizziness, pressure changes, pale skin, swelling in the area of injury.

Neck injury

Somersaults, diving, road accidents and objects falling on the head often provoke displacement of the cervical vertebrae in children. This section of the spinal column is the thinnest, so the slightest sudden movement in combination with tense muscles can cause compression.

Symptoms of a neck fracture:

neck pain;
turning the head is unnatural;
neck muscle tension;
rotational mobility is limited;
when bending the head forward there is a sharp pain;
the back of the neck is smoothed;
V in rare cases- paralysis of the body.

Thoracic injury

The most common injuries are to the thoracic region, which occur due to a fall on the back from a height. For the first time, children experience difficulty breathing.

The main signs of damage to the thoracic vertebrae:

pain;
pain during movement and palpation intensifies;
back muscles are tense;
movements are constrained;
abdominal pain;
hematomas.

Lumbar injury

Lumbar vertebrae can be damaged when sharp drop on the buttocks, lifting weights, physical impact on the lower back. After an injury, the baby will try to lie on his back or on his stomach on his knees, clasping them with his arms. This position relieves pain.

Symptoms of injury:

the muscles in the lumbar area are tense, the back is bent;
pain on palpation;
vertical position tires the child;
lower back pain increases when you tap your heels;
girdle pain in the abdomen of a spasmodic nature;
tension in the anterior walls of the peritoneum;
when bending the body forward there is an unpleasant sensation.

Important! Any back injury is dangerous.

If a child has a spinal injury, then before the medical team arrives, he should be given assistance to prevent the displacement of the vertebrae, as well as their additional deformation.

First aid for a spinal fracture or other injury involves immobilizing the victim and transporting him to the emergency room as quickly as possible.

Until the medical team arrives, adults can take a number of necessary measures:

If there is a blow to the lumbar region, the baby must be placed on his stomach, and a soft pillow or rolled-up cloth or jacket placed under his head.
In case of a blow to the chest area, on the contrary, the victim should be laid on his back and preferably on a surface that is as hard as possible.
If the cervical spine is damaged, you must be very careful in your actions, since any careless movement can cause damage to the spinal cord. With this injury, it is better not to touch the child until the ambulance arrives.

Important! You cannot try to straighten your child’s spine on your own!

The best action is to cover the child's body with soft objects that will help prevent unnecessary movements. If a minor injury to the tailbone or back occurs, then it is not advisable for the patient to sit, stand, or move for some time.

It should be remembered that any load on the spine after an injury may cause complications.

Diagnostics

Diagnosis of injury is carried out only by a traumatologist. With minor compression, it is not easy to identify damage - the symptoms are mild. Therefore, they first carry out thorough palpation and tapping in the area of the bruise. This will help identify the most painful area. Gentle pressure on the head and shoulder girdle will also help identify a spinal injury.

To make an accurate diagnosis, the traumatologist carries out various research activities:

X-ray - it is carried out in two projections, lateral and direct, which allows you to accurately identify existing damage and the degree of severity.
Magnetic resonance imaging - the procedure is prescribed in cases where a specialist suspects damage to the nerve endings in the spine.
Computed tomography - this must be performed after receiving x-rays for a more thorough study of the spine and existing injuries. Myelography is often prescribed simultaneously with CT scanning. With its help, you can study the condition of the child’s spinal cord in the area of the injury.
Densimetry helps identify the presence of osteoporosis.

When examining a patient instrumental methods, he is also prescribed a neurological examination, which allows him to assess the functioning of the spinal cord, the condition peripheral nerves and roots.

Treatment

If you suspect this injury in a child, parents should seek advice from a traumatologist, who, after making a diagnosis, will prescribe the necessary treatment. The treatment method will depend on the degree of damage and the location of the injury - surgical or conservative.

Conservative treatment

traction;
wearing a corset.

This therapy is used to treat grade I compression fractures. Its main goal is complete liberation spinal column from load. This can be achieved using traction.

For injuries to the neck and upper thoracic region, a Glisson loop is used.
If the thoracic region is injured below the 14th vertebra, the patient needs traction by the armpits.
In case of injury to the lower back, lower thoracic region, or a fracture of three vertebrae is diagnosed, wearing a corset is prescribed for a period of more than three months.

Conservative treatment can be divided into three stages:

I - pain relief, traction. The child is prescribed painkillers to reduce discomfort. During treatment, it is necessary to observe strict bed rest at a 300 incline on a hard surface for a period of five days.
II - restoration of normal blood supply in the damaged area. This stage lasts up to two weeks. The patient undergoes courses of magnetic therapy and electrophoresis.
III - formation of a muscle corset. In addition to physiotherapy, bed rest with traction, a back massage is prescribed.

Exercise therapy is performed at all stages of therapy.

Surgical intervention is carried out in case of complex injuries, when the installation of a special solution is necessary to correct the height of the damaged vertebrae. Surgery is also necessary if there are bone fragments or damage to the child’s spinal cord. In these cases, special metal fixing structures are installed.

Recovery time after surgery lasts longer and also includes exercise therapy and massage.

Rehabilitation

The rehabilitation course after a compression fracture is divided into several levels:

The first month after the injury, the child should be in the hospital under the full supervision of medical staff. He is prescribed bed rest without movement using vertebral traction on a special device - the Glisson apparatus and the Delbe device. The bed should be tilted. This helps the patient reduce tension in the back muscles and straighten the vertebrae along their entire length.
The second month of rehabilitation is aimed at restoring the muscles and ligaments of the back. During this period, the child is allowed to get out of bed and move for a limited period of time.
For a year after the injury, the child should sleep on a hard surface without a pillow. He must also visit the physical therapy room and regularly perform special exercises to restore all functions and flexibility of the spine. Also in mandatory physiotherapeutic procedures should be carried out.

For full recovery after a compression fracture of the spine and strengthening of its functions, the minimum period that may be needed is two years.

After being in a stationary position for a long time, the bones and muscles of the victim do not receive the proper tone, and therefore they need a long recovery process to return to their previous healthy state.

You can begin physical activity no earlier than two months after receiving the injury. However, this period may be reduced or increased. It all depends on the nature of the damage.

The child is prescribed to wear a special neck and back brace, but is completely prohibited long period time to sit on a chair or armchair. It is only allowed to lie on your back or walk in a corset.

The rehabilitation period is aimed at restoring blood circulation in spinal muscles. Congestion that appears after wearing a rigid corset can be eliminated with special movements. A set of exercises is selected individually for each patient.

A course of physical therapy must be carried out for at least one year after stopping wearing a corset. Combining physical pumping of the back and abdominal muscles with massage is the most effective complex rehabilitation.

The objective of this course is not only to strengthen the muscular skeleton, but also to regulate the work internal organs, which have been compressed by a corset for a long time.

The most effective physiotherapeutic measures are visiting electrophoresis to dilate blood vessels and capillaries, magnet therapy, paraffin treatment, water procedures and massage. Exercising in the pool is good for restoring the spine. Therefore, his visit should become regular for the child.

Complications and consequences

To the very severe complications vertebral injuries include neurological disorders- paralysis, loss of sensation in the limbs. Common consequences of spinal injury are vertebral necrosis, kyphoscoliosis, radiculitis, osteochondrosis, spondylitis and scoliosis.

With timely and competent treatment of a compression fracture of the spine, the risk of complications and other negative consequences is minimized.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!

The spine is the basis of every human body. This is the island of life; most diseases are reflected in the spine. Therefore, it is important to monitor its normal condition and promptly consult a doctor in case of injuries or incipient pain. It is important to understand that it can cause problems in the internal organs, especially for injuries with bruises of internal organs and bleeding.

What is it?

A compression fracture of the spine in children disrupts the integrity of the spinal column, primarily affecting the vertebrae. Compression usually begins. With a strong impact, the vertebra is seriously injured and destroyed. A fracture of the thoracic vertebra in children often occurs due to active games, when the child forgets about safety and caution.

Reasons

The main cause is mechanical injury. It can be obtained as a result:

Falls from a height onto the back, legs or buttocks;
Sharp bending of the back during a somersault;
A strong blow to the spine;
Hitting your head while jumping or diving. Cervical injuries are common in water.

A pediatric compression fracture occurs due to the following conditions:

A healthy spine can withstand serious physical stress. If it is weak or underdeveloped, then even minor damage can lead to compression injuries;
Osteoporosis is common in children. It reduces bone density, thereby increasing the risk of compression injuries when running, walking and even squatting;
Poor nutrition results in a lack of vitamins, minerals and trace elements in the body. As a result, bones become more fragile and the condition of the entire body worsens.

In a child, a compression fracture of the spine is often combined with other injuries. This could be a fracture of the pelvis, arm or concussion. The reason for this is mobility and childlike spontaneity, in which fear is completely absent. Children often forget about safety in the rush of playing, running or physical education class.

Symptoms

Symptoms of a spinal fracture in a child are not always obvious. There may be pain varying degrees severity, and limited movements do not always occur in an acute form.

Symptoms of a compression fracture of the spine in a child depend on the location:

With a compression fracture of the thoracic vertebrae in children, the pain is located in the area of the shoulder blades. It is encircling in nature. Immediately after receiving the injury, it is obvious, and you may begin to hold your breath every few seconds. The skin in this area becomes pale and blue. First you need to restore breathing and then the pain will decrease and become less noticeable;
If the injury occurred in the lumbar region, then respiratory system not damaged. There may be pain in the abdominal area;
If the cervical spine is damaged, pain occurs when rotating the head or touching the site of impact.

Signs of a compression fracture of the spine in children may be as follows:

Violation of the urination process;
Paralysis;
Pressure surges.

In some cases, after being injured, the child cannot get up and walk. He must be taken to a specialist in a supine position. If a child has a mild spinal fracture, he will most likely be able to move independently. For this reason, children often hide the injury from their parents and end up in the hospital after a long time.

Your health will gradually deteriorate. In case of any injury, you must consult a doctor immediately to avoid consequences. At mechanical injury Damage to internal organs often occurs, so it is important to start treatment in a timely manner.

Diagnostics

The diagnosis is carried out by a traumatologist. He examines the situation in which the injury occurred and assesses the severity of the injuries received. First, he performs tactile palpation of the spine to identify painful areas.

In the case of a severe form of compression fracture of the thoracic vertebrae in children with displacement, the doctor prescribes treatment. The inspection does not provide an accurate result of integrity and therefore additional diagnostic procedures must be performed.

Pediatric vertebral compression fracture: diagnostic procedures

X-ray. Allows you to detect bone fractures in the shortest possible time. Carry out in lateral and direct form to eliminate research error. After it is carried out, if necessary, they can apply splints and prescribe surgery;
MRI. It is carried out to diagnose damage to nerve endings;
CT. It is used for detailed study of damaged tissue areas in order to identify internal damage bones. This procedure is mandatory if there is a bruise at the site of the impact. It may mean internal bleeding;

Densitometry. A study that allows you to study in detail the condition of bone tissue. This is especially important if the child has osteoporosis.

Treatment

For minor injuries, children are often brought to the clinic for diagnosis by their parents. At the same time, the kids move themselves and complain about dull pain in the area of the shoulder blades. But this approach is dangerous to health.

If the child cannot move, then it is strictly forbidden to shake him or turn him over. Before the ambulance arrives, parents need to constantly talk to him so that he does not lose consciousness; it is important to calm the baby down and tell him that you are nearby and he will soon feel better.

Uncomplicated compression fracture of the spine in children is treated in the clinic. After all necessary procedures the child is undergoing outpatient recovery under the supervision of a surgeon and traumatologist. If the injury is complicated, then treatment and rehabilitation takes place in a hospital setting. The duration of treatment is determined individually depending on the complexity of the injury. Compression fracture of the 6th spine in children is treated in a hospital.

Treatment and rehabilitation in children

The stages of recovery depend on each specific case, but we will consider the traditional approach, which has been practiced in clinics for many years:

Actions aimed at stopping pain with the help of medications. In cases of severe injury, strong analgesics may be prescribed;
Research is being conducted to identify the characteristics of the injury. Selected optimal method treatment: surgical or conservative;
Rehabilitation of patients through recovery physical condition, normalization of muscle tone and functions of flexion and extension of the spinal column.

It is important to remember that after rehabilitation, the child needs to maintain a calm lifestyle without heavy physical activity. For some time he is strictly forbidden to play sports or play active games.

Compression fracture of the thoracic spine in children: conservative treatment methods
To restore damaged vertebrae, a corset is installed for a compression fracture in a child. It allows you to restore your normal shape and quickly return to normal life. If the injury is not severe, the child is treated conservative treatment and quickly returns to his usual active life.

Types of therapeutic treatment:

Functional therapy is used when the spine is compressed by a third and damage to the nerve tissue has not been confirmed. The treatment is aimed at correcting and restoring the spine by stretching it on an inclined surface;
Reposition. Gradual recovery by increasing the angle of inclination of the surface where the child is located. This could be a bed with a hard mattress. The level of extension and flexion gradually normalizes and the person returns to normal life.

Surgical intervention

A complex compression fracture of a thoracic vertebra in a child may require surgery. In case of moderate to severe injury, surgical operations are prescribed.

For children, closed surgery using local anesthesia is used:

Introduced special remedy into the damaged vertebra. To do this, a small puncture is made on the skin with a needle;
Restoring the shape of the bone ring. The operation is performed using a thin tube. With its help, a balloon is placed into the vertebra, which forms the required form and height. After completion of the work, it is removed from the cavity, and the formed space is filled with a special solution, which quickly hardens.

What does this give?

Reducing pain;
Normalization of the damaged vertebra and prevention of its prolapse;
Normalization of the correct shape of the curves of the spine;
Reducing the likelihood of future fractures.

In some difficult situations, children are given open surgery. Under general anesthesia. In it, specialists restore the vertebra and connect it to its neighbors using fixation. A fracture of the thoracic vertebra in a child is serious problem, with which you must immediately consult a doctor in order to provide assistance as quickly as possible and avoid serious consequences in the future.

Rehabilitation

First medical care and treatment is only part of normalizing the condition after injury. This is followed by long-term rehabilitation, which includes a set of necessary procedures. Prescriptions for this period are made by a surgeon or traumatologist, depending on who initially conducted the treatment. A compression fracture of the 7th thoracic vertebra in a child can have consequences if assistance is not provided in a timely manner.

The duration of rehabilitation depends on the severity of the injuries, the child’s health and age. It can take place in a clinic or at home. A fracture of the 6th thoracic vertebra in a child requires a long rehabilitation process with a visit to a physical therapy center.

Rehabilitation treatment plan:

Therapeutic exercise. It includes exercises to normalize breathing, the functioning of the cardiovascular system and the gastrointestinal tract. Exercises that are aimed at strengthening muscles and preventing deterioration of the condition muscle strength;
After the end of the main treatment, exercise therapy is carried out for several months. The exercises are aimed at restoring the muscle corset and preparing the body to return motor activity. During this period, new procedures are constantly introduced to gradually increase the load on the body. Not only the number of exercises increases, but also the time spent practicing. The child’s reaction to increased loads is checked and monitored;
Next, the child is prepared for vertical loads. To do this, exercises with resistance and obstacles are introduced into the treatment program. The final stage of recovery is exercises performed while standing without support. Deadlines rehabilitation period in each case are individual and depend on the severity of the injury and the characteristics of the patient;
Massage. It is part of a comprehensive approach to treatment and allows for faster recovery from injury.

Recovery period

For quick treatment and recovery, you must follow all the doctor’s recommendations. Yes, it’s difficult to explain to little ones why they can’t run and jump, but it’s in your interests. The injury is serious and can have serious consequences in the future, so wasting time tormenting yourself is simply pointless. It is important to maintain bed rest and keep your child busy with quiet games and reading in bed. Limit movements, and especially not allow active games and running.

After finishing treatment in the hospital, a new difficult stage of returning home will begin in your life. There they also treat walls, but there it is more difficult to monitor them around the clock active child who doesn’t understand why he can’t do anything. If necessary, you should not refuse to wear a corset, as it allows you to quickly restore the shape of the spine and strengthen its structure.

Medicines must be taken strictly as prescribed by the doctor, even if you think that they are no longer necessary. It is necessary to restore tissue, and this requires vitamin complexes and missing vitamins.

Visit therapeutic massage necessary without gaps. This important stage restoration, which requires a very serious and meticulous approach. Nutrition also needs to be regulated. It is important to make your diet varied and complete nutrients to strengthen and restore bone tissue.

Consequences

If a doctor was not called in the event of a spinal fracture and appropriate treatment measures were not taken, this may affect future health and lead to:

To spinal cord injuries with the formation of paralysis;
To tissue deformation;
To neurological disorders;
To the occurrence of osteochondrosis;
To vertebral instability, which increases the risk of fractures in the future.

Any disease leaves an imprint on a person’s health. Only with timely and competent treatment can the consequences be avoided.

Children do not always inform their parents about their injuries, so it is important to take an interest in the child’s health every day and look at his behavior and behavior. possible deviations in movements. Remember, timely help is the key to health!

Spinal injuries in children are relatively rare.

In relation to all fractures occurring in childhood, they amount to 0.7-1.3%.

What Causes Spinal Injuries in Children?

The main type of violence is bending as a result of a fall from a height or a heavy weight falling on the victim’s shoulders. More frequent clinical form spinal injuries are compression wedge-shaped fractures of the vertebral bodies. Fractures of the spinous and transverse processes and very rarely isolated fractures of the arches are observed much less frequently. According to research, out of 51 injured children with spinal injuries, an isolated fracture of the arch was observed in only one, while compression fractures of the vertebral bodies were present in 43 children. Most often, fractures are localized in the middle thoracic region. More often there are not single, but multiple fractures. The above-mentioned features are explained in the anatomical and functional characteristics of the child’s spine and in the characteristics of the child’s relationship with the external environment.

Spine in children: anatomical and functional features

The child's skeleton is richer in organic matter, which gives it significant flexibility and elasticity. Its vertebral bodies contain large number cartilage tissue grouped in the area of growth zones. The smaller the child, the less cancellous bone is contained in the body of his vertebra. Well defined, tall, elastic intervertebral discs with high turgor are excellent shock absorbers that protect the vertebral bodies from the effects of external violence. The middle thoracic intervertebral discs have the smallest relative height. According to A.I. Strukov, in the bodies of the upper and middle thoracic vertebrae the bone beams are located predominantly vertically and have short horizontal anastomoses, while in the bodies of the lower thoracic vertebrae the network of vertical beams is closely intertwined with an equally well-defined network of horizontal beams, which and gives the bodies of the lower thoracic vertebrae greater strength. Finally, the bodies of the middle thoracic vertebrae are located at the apex of the physiological thoracic kyphosis. These three anatomical prerequisites - the smaller height of the intervertebral discs, the architectonics of the vertebral bodies, the location at the height of kyphosis - are the reason for the most frequent fractures bodies of the middle thoracic vertebrae.

The anatomical features of the child’s vertebral bodies are also reflected on spondylograms. According to V.A. Dyachenko (1954), the vertebral bodies of a newborn are ovoid in shape and separated from each other by wide intervertebral spaces, which lumbar region equal to the height of the bodies, and in the thoracic and cervical ones slightly less than the height of the bodies of the corresponding vertebrae.

On the profile spondylogram of children of this age, strictly in the middle of their dorsal and ventral surfaces, there are characteristic slit-like notches resembling the lips of a closed mouth (G.I. Turner). These depressions are the site of entry of intersegmental vessels, mainly vv. basivertebrales. In later periods of a child’s life, these slits are identified only on the ventral surface of the bodies. In the lower thoracic and upper lumbar vertebrae, these gaps can be traced up to 14-16 years of age.

In a child aged 1.5-2 years, on a profile spondylogram, the vertebral bodies appear as regular quadrangles with rounded corners. Subsequently, the rounded edges of the vertebral bodies undergo changes and acquire a stepped shape, which is caused by the formation of a cartilage ridge. Such “stepped” vertebrae are observed in girls up to 6-8 years old, in boys - up to 7-9 years old. By this age, additional ossification points appear in the cartilaginous ridges, which radiologically, according to S. A. Reinberg, become visible at 10-12 years of age.

They are most well expressed in the anterior sections. Their appearance is very variable both in terms of timing and location. Continuous ossification of these cartilaginous ridges is detected by 12-15 years, partial fusion with the vertebral bodies - by 15-17 years, and complete fusion with the vertebral bodies - by 22-24 years. At this age, on spondylograms, the vertebral bodies appear in the form of a rectangular quadrangle, and on the posterior spondylogram, the surfaces of this rectangle are somewhat depressed.

Symptoms of spinal injury in children

Clinical diagnosis of spinal fractures in children can be difficult due to the ingrained idea that spinal fractures almost never occur in childhood.

A carefully collected history and detailed clarification of the circumstances of the injury will allow one to suspect the presence of a fracture. The doctor's attention should be drawn to such information from the anamnesis as a fall from a height, excessive bending when tumbling, or a fall on the back. When falling on the back, a flexion compression fracture of the vertebral bodies is apparently explained by the immediate reflex flexion of the upper segment of the body, which leads to compression of the bodies. This moment of forced flexion in the history is difficult to identify, since it goes unnoticed by the victim and usually does not appear in his story.

As a rule, children experience uncomplicated, milder forms of spinal injury.

The most common complaint of victims is pain in the area of spinal injury. The intensity of this unprovoked pain in the first hours after injury can be significant and pronounced. The pain intensifies with movement.

On examination, abrasions and bruises may be noted. various localizations. Usually general condition casualties are quite satisfactory. In some very rare cases, pale skin and increased heart rate are noted. If the lumbar vertebrae are damaged, there may be abdominal pain and tension in the anterior abdominal wall. Of the local symptoms, local soreness is the most consistent. which intensifies with movement and palpation of the spinous processes, as well as varying degrees of limitation of spinal mobility. Axial load on the spine causes pain only in the first hours and days after injury. On the 2-3rd day, this symptom, as a rule, is not detected.

Rapidly passing radicular pain and symptoms of spinal cord concussion may occur. In a significant proportion of cases, all these symptoms disappear by the 4-6th day, and the condition of the injured child improves so much that the doctor does not think about a spinal injury.

Fractures of the transverse processes are characterized by limitation and pain when moving the legs, pain when trying to change position in bed. Fractures of the spinous processes are distinguished by the presence of abrasions and bruises at the level of the fracture, local pain, and sometimes the mobility of the broken process is determined.

Diagnosis of spinal injury in children

When diagnosing compression fractures of vertebral bodies in children, spondylography is especially important. important, since it is often the only opportunity to make a correct diagnosis in a timely manner. The most reliable radiological symptom Compression fracture of the vertebral body is a decrease in the height of the fractured vertebral body. This reduction can be very inconclusive and controversial, barely noticeable, but it can also be significant, up to a reduction in body height by half of its normal height. The decrease in height can be uniform, covering the entire length of the body, or limited to its ventral sections. A decrease in height can be observed as a bevel of the endplate with some apparent compaction due to compression of the subchondral layer of bone. Condensation of the bone trabeculae of the vertebral body may be observed. There is a sliding of the endplate anteriorly, often cranially, with the formation of a protrusion. A.V. Raspopina described the symptom of asymmetric location of the choroidal fissure or its disappearance on a broken vertebra. All these symptoms are revealed on a profile spondylogram. An anterior spondylogram is of significantly less diagnostic value.

In differential diagnostic terms, one should remember about congenital wedge-shaped vertebrae, apophysitis and some other anomalies of vertebral development, which can be mistaken for fractures.

When X-ray diagnosing fractures of the transverse and spinous processes, one should remember about additional points of ossification, which can be mistaken for fractures.

Treatment of spinal injury in children

Treatment should ensure unloading of the broken vertebral bodies and prevent their further deformation. With proper and timely treatment, the shape of the broken vertebra is restored. The smaller the child, the more pronounced the growth potential, the faster and more complete the recovery occurs. anatomical shape broken vertebra. There is usually no need to anesthetize the body of a broken vertebra, since in children this procedure is much more painful than the pain they experience.

The treatment consists of placing the injured child on a hard bed in a supine position with light unloading by traction along an inclined plane with traction armpits. Thick bags for reclination are placed under the fracture area. Children require constant attention from the staff, since quite quickly after the pain disappears they consider themselves healthy and do not comply with the treatment regimen. They can also be placed on a soft bed in a prone position. It is better to combine these two provisions. A change in position brings variety to a child's life, but it is easier for him to put up with being forced to stay in bed. From the first days they carry out therapeutic exercises according to the complexes described above.

The length of time a child stays in bed depends on the degree of compression of the broken body, the number of damaged vertebrae and the age of the victim. This period ranges from 3 to 6 weeks. The child is transferred to a vertical position in a special reclining lightweight corset. Children should be kept from sitting as long as possible. The duration of wearing a reclinator and doing physical therapy is on average 3-4 months. They must be individualized in each individual case and are dictated by the child’s well-being and the data of the control spondylography. For fractures of the appendices, treatment is carried out with rest on a hard bed for 2 weeks.

In these cases, according to appropriate indications, the entire complex should be carried out necessary treatment. In case of complicated fracture-dislocations, there may be a need for closed reduction of displaced vertebrae, revision of the contents of the spinal canal, and surgical stabilization of the spine. Stabilization, depending on the level and nature of the displacement, as well as the return of patients, is carried out either with a wire suture, or metal plates with bolts, or plates with bolts in combination with posterior spinal fusion. In each individual case, all these issues are resolved strictly individually, taking into account the characteristics of a particular patient.

Consequently, spinal fractures in childhood have a number of features that are determined by the anatomical and physiological features of the structure of the children's spine. At the same time, children may also have “ordinary” spinal injuries characteristic of adults, which should be treated with appropriate methods and methods, taking into account the characteristics and differences of the child’s body.

Compression fractures of the spine are less common in children than in adults. Among all back injuries, this type of injury accounts for about 2% of cases. But each of these cases requires careful diagnosis, proper treatment and quite long rehabilitation. Therefore, parents should know what the symptoms of injury are, how to provide emergency first aid and what basic principles should be followed during the rehabilitation process. We will tell you more in this material.

About the injury

Compression is the process of compression. A fracture is considered a violation of the integrity of bone tissue. Thus, a compression fracture means a disorder in which a fracture is combined with compression. When the spine is injured with compression, there is a violation of the structure of one or several vertebrae at once with an obligatory compressive effect, as a result of which the height of the vertebral bodies is disrupted.

A child can get such an injury anywhere - in a physical education lesson, on the playground, or when falling from a bicycle. Typically, compression occurs as a result of a forced load on the longitudinal axis of the spine, a sharp flexion movement. Quite often, compression occurs as a result of flexion and impact at the same time.

It should be noted that compression injury of the spinal column does not always imply damage to only one vertebra. Several vertebrae may be broken at once.

A child can be injured without being injured as such. This becomes possible if he has osteoporosis or a tumor in the vertebral area, for example, a hemangioma inside the vertebral body. In this situation, it is not at all necessary to fall from a swing or jump from the roof of a garage. A sharp flexion movement will be enough for the vertebra to be damaged, and the vertebrae adjacent to it would compress it.

A compression fracture can happen to anyone; any part of the spine can be injured. But most often, according to the observations of pediatric traumatologists, children break the lower vertebrae of the thoracic spine and the upper ones of the lumbar spine.

The structural feature of children's vertebrae is that their height is more perfect, depreciation is better than the height of adults, and therefore compression cases of vertebral fractures in childhood occur somewhat less frequently. But the injury is considered dangerous, and therefore requires special treatment from both doctors and the child’s parents.

The danger of this injury lies in the risk of disability. Inside the spinal column there is a spinal cord, numerous nerve endings that are responsible for the functioning of internal organs.

If the compress causes nerves and spinal cord to become pinched, the child may be paralyzed. But there is good news: bone tissue children are more elastic, it recovers faster, and therefore the chances of successful rehabilitation, if the injury occurred in childhood, is significantly higher than with a similar injury, but in an adult.

How is it happening?

Knowing what a compression injury looks like, as well as the essence of the processes at this moment in the spine, you can easily imagine what events could precede the injury. Most often, children receive a compression fracture when landing on straight, outstretched legs. Some people practice such jumps from the sofa to the floor, and some from the roof of the garage in the yard. Height, of course, matters, but in fact both of them risk getting serious injury And unpleasant consequences. Jumping on straight legs is often performed by schoolchildren in physical education lessons, since when performing a long jump, most children who are far from sports violate the technique of performing the exercise, and physical education teachers do not always monitor this.

A vertebral fracture with compression is often a consequence of a fall on the butt. It is important to understand here that landing on your buttocks from your own height is not as dangerous as falling from greater height, for example, from a moving swing.

If a child falls, one or two vertebrae are usually affected, and the injury is isolated. If the injury is received as a result of an impact after a jump from a great height, during an accident, then it is most often combined, accompanied by damage abdominal cavity, brain, limbs.

Types of vertebral compression

To determine the type of injury, the exact location of the fracture is of primary importance, Based on this feature, several types of compression fractures are distinguished:

cervical;
chest:
lumbar;
sacral;
coccygeal

Most rarely among toddlers and adolescents, compression fractures occur in the neck and tailbone area. But injuries to the thoracic and lumbar spine are common. Depending on the degree of compression and reduction in vertebral height, there are the following types injuries:

1st degree compression injury- the height of the injured vertebra is reduced by less than one third;
2nd degree compression fracture- the height of the injured vertebra is reduced by less than half;
compression injury 3rd degree- the height of the damaged vertebra is reduced by more than half.

A grade 3 fracture is considered the most severe, since it actually involves crushing the vertebral body.

Additionally, traumatologists determine the type of vertebral lesion. Based on this feature, burst fractures, impacted fractures, and fractures with vertebral splitting are distinguished.

Fractures that occur as a result of trauma are called traumatic, and fractures that result from a tumor or other pathology in the spine are called pathological.

Symptoms

The main sign of a compression fracture is sharp, severe pain. If a vertebra in the thoracic spine is broken, the child may additionally experience difficulty breathing at the time of injury. Some time later, the child may begin to complain of pain in the area of the injury, which subsides somewhat when lying down, but invariably intensifies when standing, sitting, and also with movement.

With a severe fracture, the child may vomit and experience severe headache, numbness of the limbs. If you examine the damaged spine, there may be slight swelling in the area of the fracture. Touching the injured vertebra causes the child to experience an attack of pain, and the muscles in the vicinity of the injured vertebra are tense.

Often, the method of pressing the palm of your hand on the head (on the crown) helps determine a spinal fracture. In this case, the pain in the vertebra should intensify. But when determining lesions in children, this method is contraindicated - additional compression can lead to increased compression and aggravation of the baby’s condition.

Pathological fractures (due to a tumor or osteochondrosis) are rarely accompanied by severe symptoms. They often appear completely unnoticed. The child begins to complain of pain when the height of the vertebra becomes greatly reduced, when a feeling of numbness appears in the fingers or in the area of the feet.

When the roots are compressed, the first symptoms may not be pain in the vertebrae at all, but other disorders: decreased hearing or vision (in case of injury in cervical spine), headaches, numbness of the extremities (with injury in the lumbar region), difficulty taking deep breaths (with injury in the thoracic region).

First aid

The correct provision of first aid to a child if a compression fracture of the spine is suspected is important, and every parent should at least have a general idea of how to help a child. To begin with, it should be noted that in case of any fall (by the methods described above) and complaints of back pain, adults should first suspect compression. This is the very case in which it is better to play it safe.

It is better not to touch the child, and do not try to transport the child to the hospital or emergency room yourself. Moving can lead to a change in the position of the injured vertebra and worsen the baby’s condition. Try not to change your body position.

If it is not possible to leave the child in place until the ambulance doctors arrive, you should carefully, with outside help (by the arms and legs, with the back supported by a third person), transfer the child to a hard surface and lay him on his back.

Under no circumstances should you sit the victim down; in a vertical position, the pressure on the vertebrae increases many times over. If there is a suspicion of a fracture in the coccygeal area, the child should be placed on his stomach.

If there are drugs non-steroidal group painkillers, you can give the child an injection. Diclofenac and Ketanov in an age-specific dose are suitable for this. But you should not give your child painkillers in tablets, since the swallowing reflex may be impaired and the child will choke. Coughing, which occurs reflexively, can lead to additional displacement of the injured vertebrae.

Transport the child to medical institution only possible on hard stretchers. The child must be immobilized and restrained as firmly as possible. If parents volunteer to help doctors load the stretcher into the ambulance, remember that all movements must be very careful and smooth.

Treatment

The injury is initially treated in a hospital setting. The child will be on a hard “shield” – a bed – for 6 weeks. He will be given painkillers and will also be shown special complex physical therapy exercises to strengthen the muscles.

After a month and a half, the doctor allows a special massage and a visit to the physiotherapy room. Electrophoresis and calcium sessions are especially useful at this stage of rehabilitation.

For two months after this, the child must wear a special orthopedic fixation corset. In case of an uncomplicated compression fracture, he will be able to return to school no sooner than in six months. Complete restoration will take 2-3 years.

For complicated fractures, surgical treatment is indicated. There are two types of surgeries performed on children - vertebroplasty and kyphoplasty. Both types of interventions fall into the category of high-tech types of medical care.

In the first case, doctors make a small incision and inject special bone cement into the vertebral body, which hardens and does not allow the vertebra to collapse. During kypholasty, the shape of the vertebra is first corrected, after which the same bone fixing cement is injected. For each type surgical intervention There are indications and contraindications.

If the injury causes pinched roots and nerve endings, open spinal surgery is usually performed, during which surgeons manually free the roots. To stabilize a mobile broken vertebra, various metal structures can be used - screws, rods, etc., exact type The device is determined by the doctor depending on the nature of the injury.

Completely destroyed vertebrae are replaced with bone grafts and prostheses. Postoperative period and rehabilitation after surgical treatment Compression fractures are quite complex and long-lasting. They will require patience and a lot of work from relatives and doctors. For recovery, massage, physiotherapy, and systematic exercise therapy are used strictly under the supervision of a specialist in the field of physical therapy and restorative gymnastics.

Komarovsky about injury

Well-known pediatrician Evgeny Komarovsky argues that parents should not engage in “amateur activities” and apply compresses, bandages to their child and test traditional medicine on them during the treatment process and during the recovery period after the child receives a compression injury to the spine. The other extreme, which Komarovsky warns against, is excessive physical inactivity during rehabilitation. Parents must understand that movement will only benefit the child, and recovery will be faster.

The pediatrician calls swimming, walking on fresh air, exercise on an exercise bike, unless, of course, the attending doctor objects to this kind of physical activity.
peace;
lack of movement;
cold;
painkiller from the home medicine cabinet.

Komarovsky categorically advises parents not to try to palpate or adjust anything on their own. In addition to the fact that this will cause severe pain to the child, this can significantly complicate the task for doctors - if there was no clamping of the roots, parents often organize it with their inept and unreasonable actions.
In the case of pathological fractures that do not differ acute symptoms, the best thing parents can do is not to avoid annual medical examinations. It will help to identify this type of injury in a timely manner if it occurs.

Forecasts

Since children's bones recover much faster than adults, an uncomplicated first-degree fracture usually has a very favorable prognosis - the integrity of the vertebrae is restored without significant consequences for the child's health.
A compression fracture of the second or third degree often has long-term consequences - episodic pain may persist, the likelihood of intervertebral hernia, which will require separate labor-intensive surgical intervention.
The prognosis for a complicated third-degree fracture, when it is necessary to replace a crushed vertebra, is considered less favorable. Often, after this, the child is entitled to a disability status, which will significantly limit his physical health and opportunities in choosing a future profession.

Timely treatment and proper rehabilitation significantly increase the chances that performance will be fully restored. Following the doctor's recommendations will allow parents to quickly get their child back on his feet.

About how to have healthy back, Dr. Komarovsky will tell you in the next video.