Taylor Tristen N, Bridges Callie S, Pupa Lauren E, Morrow Beatrice A, Smith Brian G, Montgomery Nicole I
Baylor College of Medicine, Houston, TX.
Texas Children's Hospital, Houston, TX.
J Pediatr Soc North Am. 2024 Feb 12;5(3):697. doi: 10.55275/JPOSNA-2023-697. eCollection 2023 Aug.
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. 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. 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. 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. Level IV.
•Pathologic Vertebral Compression Fractures occur commonly in children with primary or secondary osteoporosis or due to primary site lesions, such as metastases.•Patients often have multiple fractures about the thoracolumbar and mid-thoracic regions of the spine.•Wedge and biconcave fractures were the most common fracture type at presentation and indicated an underlying disease not previously known in one-third of patients.•MRI is useful for distinguishing between benign fractures and malignancy as the etiology of the fracture.
压缩性骨折常与低能量创伤相关，可能发生在与遗传疾病、内分泌疾病、肿瘤性疾病、感染及炎症性疾病相关的骨骼健康异常的情况下。文献中没有关于病理性儿童压缩性骨折患病率或病因的重要系列研究。在一家三级儿童医院于2012年至2022年进行了一项经机构审查委员会批准的回顾性研究。纳入了年龄小于18岁、诊断为非创伤性椎体压缩性骨折的患者，并对其人口统计学、潜在诊断/合并症、表现、活动能力、畸形、影像资料、治疗及结果进行了回顾。纳入了181例患者（54%为男性），平均年龄14.17岁，随访时间为20个月。32%的患者中，压缩性骨折是潜在诊断的首发症状，21%的患者接受了磁共振成像（MRI）以区分转移性疾病和良性骨折。15%的患者病因是原发性骨质疏松症，65%是继发性骨质疏松症；最常见的原因是免疫抑制剂（46%）和急性淋巴细胞白血病（ALL）（10%）。20%的患者病因是原发性病变。每位患者骨折的中位数为3处，大多位于胸中段（82%）和胸腰段脊柱（51%）。X线片显示82%为楔形骨折，22%为双凹形骨折，12%为椎体扁平。患者的治疗方式包括观察（46%）、支具固定（31%）、双膦酸盐治疗（31%）和融合手术（4%）。到最后一次随访时，出现脊柱侧弯或需轮椅辅助行动的患者比例更高。总体而言，死亡率为16%，大多与癌症相关。总体而言，32%的患者以压缩性骨折作为潜在疾病的首发症状。儿童病理性椎体压缩性骨折常因免疫抑制剂、ALL和转移性疾病所致。骨折最常发生在脊柱胸腰段和胸中段，形态多为楔形。MRI对于区分良性骨折和恶性肿瘤可能有用。四级。
•病理性椎体压缩性骨折常见于患有原发性或继发性骨质疏松症的儿童，或因原发性部位病变，如转移瘤。
•患者脊柱胸腰段和胸中段常出现多处骨折。
•楔形和双凹形骨折是最常见的骨折类型，三分之一的患者提示存在此前未知的潜在疾病。
•MRI对于区分良性骨折和作为骨折病因的恶性肿瘤很有用。
