L2-L3 Flexion-Distraction Injury Treated by Posterior Fusion Using Ultra-High Molecular Weight Polyethylene Tape in a 7-Year-Old Boy

Abstract

A 7-year-old boy was sitting in the back seat of a car wearing a lap seatbelt when the car was involved in a head-on collision with another vehicle. Radiographs revealed mild scoliosis, anterior column compression of L3 and enlargement of both the intervertebral foramen and interspinous distance between L2 and L3. Computed tomography revealed bilateral L2-L3 facet joint disruption with fracture of the L2 spinous process. Magnetic resonance imaging revealed rupture of the posterior ligamentous complex. An open reduction and posterior fusion with autologous bone graft using 5-mm-wide ultra-high molecular weight polyethylene tape sublaminar wiring was performed. Three months after surgery, bony fusion of L2-L3 was observed. At 6 months after surgery, the patient was asymptomatic and had resumed previous activities.

Flexion-distraction Injuries in Children and Adolescents

“…Of these studies, 1 had a sample size greater than 20 patients, 7 four had between 10 and 20 patients, 4,[8][9][10] five had between 4 and 9 patients, 1,5,11-13 and 15 were case series or case reports with 3 or fewer patients. 3,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] Demographic Data. Patient age was available for 115 patients in these studies and ranged from 2 to 17 years.…”

“…cme ARTICLE Neurologic Injuries. Rates of neurologic injury varied widely across the literature, with some reporting a 0% rate of neurologic injury 8,9,[13][14][15][16][17]19,21,[25][26][27] and others reporting paraplegia rates as high as 30%. 4 The largest series available reported spinal cord injury resulting in paraplegia in 2 (7.7%) of 28 patients and nerve root injuries in 4 (14.3%) patients.…”

“…Patients managed surgically were treated with instrumented posterior spinal fusions using a variety of implants, including pedicle screws, Harrington rods, 11,12 Cotrel-Debousset instrumentation, 20 lamina plates and cables, 14 spinous process wiring, 11,15 sublaminar wires, 11 and sublaminar fixation using polyethylene tape. 26 Only 1 study attempted to provide guidelines for injury treatment. 9 In this series of 12 patients, 4 of 7 patients initially treated with bracing required surgical intervention due to progressive kyphosis.…”