Spinal fracture through the neurocentral synchondrosis in battered children: a report of three cases.

ABSTRACT

STUDY DESIGN: Retrospective case series. OBJECTIVE: To report 3 cases of unusual spinal fracture through the neurocentral synchondrosis. SUMMARY OF BACKGROUND DATA Traumatic lesions of the spine or spinal cord due to physical abuse are rare. We report 3 cases of vertebral fractures involving the neurocentral synchondrosis in battered children. METHODS: The medical data of the 3 cases were retrospectively reviewed. We discuss the pathomechanism and treatment strategies. RESULTS: In 2 cases, the vertebral body was displaced anteriorly and, in 1 case, posteriorly, all without neurologic compromise. The lateral radiographs showed vertebral displacement, but the diagnosis could be suspected on frontal views because of interpedicular distance widening. Treatment was nonoperative with bracing in 2 cases. In the third case, a posterior epiphysiodesis was done to avoid development of progressive kyphosis of the injured spine. One child treated nonoperatively died from other traumatic lesions associated with the physical abuse. In the 2 other cases, outcome was good with a well-balanced spine in 1 case and a moderate, well-tolerated kyphosis in the other case. CONCLUSIONS: Such spinal lesions are rare but could be conservatively treated in case of anterior vertebral displacement without vertebral endplate impairment. A posterior displacement of vertebral body could be responsible for a neurologic compromise.