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Pediatric cervical spine injuries are rare. Knowledge of possible types of injury, physiological development and anomalies is necessary in order to not overlook the injury and to initiate suitable therapy. Description of the clinical assessment, Management of diagnostics and therapy of specific injuries. Based on a selective literature search and taking into consideration our own experience, typical injuries at the upper and lower cervical spine in pediatric patients are depicted. In the presence of neurological deficits, identification of the cause is crucial. Odontoid fractures and injuries to the second cervical vertebra are common in upper cervical spine injuries, compression fractures and facet joint dislocation injuries are common in lower cervical spine injuries. Depending on the location of the injury and on the grade of instability, specific therapy, including conservative treatment (orthosis, halo fixation) and operative treatment (internal fixation, fusion) might be necessary.

Current concepts of treating thoraco-lumbar burst-compression injuries are based on posterior transpedicular fixation techniques which are angular stable. However, the long-term results of this approach are controversial due to inconsistent reports and due to a paucity of data on late outcome. In the present study we analyzed 50 patients retrospectively who had an unstable burst-compression injury at T 11-L 2 (type A 3 according to Magerl) without a neurological deficit. All fractures were stabilized by an internal fixator either with or without transpedicular spongiosa grafting. Patients were treated between 1991 and 1997. Follow-up times ranged from 36 to 103 months. Follow-up examinations collected occupational, subjective and clinical data (activity score, Hannover spine score) and included radiographic measurements. The latter were used to calculate the sagittal index (SI) which measures deformities of the fractured vertebral body, and the sagittal plane kyphosis (SPK) which additionally describes an eventual destruction of the affected intervertebral disc. Compared with the preinjury status, the percentage of subjects who were able to do physical labor was reduced by half at follow-up, and four times as many patients had a permanent disability. Correspondingly, activity scores and Hannover spine scores declined significantly. After the initial surgical correction SI remained stable until follow-up, whereas SPK decreased again towards pre-operative values indicating a progressive deformity of the intervertebral disc space. Clinical results did not correlate with radiographic results, and neither the time until follow-up nor the type of fracture n or the use of transpedicular bone grafting affected clinical or radiographic results significantly.

Modern concepts of treating thoracic diseases suggest more and more the use of minimally invasive thoracoscopic techniques to reduce morbidity and save costs. For treatment of specific lesions at the thoracic spine, several thoracoscopic procedures have been performed successfully. The present report examines the feasibility of thoracoscopic osteosynthesis in two patients with ventral hyperextension injuries and anterior instability of the thoracic spine. After initial correction of the anatomical deformity, autologous bone was harvested from the anterior iliac crest. Using a ventral, thoracoscopic approach, the main location of the ventral, damaged spinal segment was identified by the covering pleural haematoma. After endoscopic ventral bone grafting, osteosynthesis was performed, using dynamic compression plates, cardan drills and screw drivers. The perioperative course was uneventful, and follow up examinations after 3 years and 9 months, respectively, revealed an unchanged stable spinal segment. Our results show thoracoscopic osteosynthesis to be technically possible, with a potential for yielding satisfying long-term results.

Open reduction and internal fixation is suggested by an increasing number of investigators as preferable treatment of displaced intraarticular calcaneal fractures. Assuming that quasianatomical reduction coincides with adequate function, many surgeons rely on morphological parameters (standard radiography, computed tomography) to demonstrate the effectiveness of surgery by achieving an optimum restoration of calcaneal geometry and joint surfaces. In order to correlate morphologic parameters and functional assessment, a prospective study was performed on 45 patients after surgical treatment of intraarticular calcaneal fractures using standard radiographic and computed tomographic scores, clinical evaluation, and gait analysis (dynamic pedography). Mean follow-up time after reconstruction was 23 months (range 18-50). Although clinical evaluation and assessment of gait function corresponded well with each other, radiographic scores showed a poor to moderate correlation with functional evaluation (r = 0.29-0.62); this was probably due to the missing analysis of soft tissue parameters. The comparison of clinical results and gait parameters with the individual radiographical parameters allowed us to identify those factors, with the greatest influence seen on the functional prognosis (i.e., calcaneal width, arthrosis in the neighboring joints). Morphologic analysis after calcaneal reconstruction based on radiographic techniques cannot predict subsequent function or substitute for functional assessment. However, it does allow for practical conclusions for surgical strategy in primary osseous reconstruction or secondary corrections.