Traumatic retropulsion of T10 vertebra in a 5-year-old boy with involvement of neurocentral synchondrosis: a case report and review of the literature.

ABSTRACT

STUDY DESIGN: This is a case report of a traumatic retropulsion of the T10 vertebral body in a 5-year-old boy. OBJECTIVES: This paper aims to describe a rare pediatric fracture where there was involvement of the neurocentral synchondrosis (NCS) and to evaluate the characteristics of this type of fractures in children. SUMMARY OF BACKGROUND DATA The NCS is the junction between the vertebral body and the pedicle bilaterally where the vertebra grows horizontally. It closes between 11 and 16 years. It is a known location for spine fracture. However, it was mainly reported in children less than 2 years of age secondary to nontraumatic injury and at the junction levels of the spine. This is the first case of a fracture involving the NCS in a child older than 2 years, due to trauma, and in a non-junctional area of the spine. METHODS: This 5-year-old boy was involved in a motor vehicle collision where he was ejected from the car. He had bilateral lower limb paresthesia and weakness. The fracture involved the neurocentral synchondrosis on the left side and impacted the vertebral body into the pedicle on the right side. Additionally, there was posterior vertebral element injury. He was treated with wide laminectomy and posterior pedicle screw instrumentation. RESULTS: At 18 months of follow-up, the patient showed a normal neurologic status and a normal alignment of the spine. CONCLUSION: Traumatic retropulsion of the thoracic spine with involvement of the NCS is possible in young age when exposed to a significant trauma. Restoration of spine alignment and normal neurological function could be achieved with a single posterior approach. KEY POINTS - Pediatric fractures are uncommon and tend to affect junction areas. - A fracture through the neurocentral synchondrosis is possible before the age of closure (11-16 years) with forcible trauma. - Single posterior decompression and instrumented fusion is sufficient to restore alignment and neurological function.