Some epidemiological indicators and results of surgical treatment of children with unstable and complicated spine injuries using different models of medical care based on the example of a constituent entity of the Russian Federation

Objective. To analyze incidence rates and prevalence of unstable and complicated spinal injuries in pediatric patients and the results of their surgical treatment using different models of medical care.
Material and Methods. A total of 117 patients under 18 years of age with high-energy traumatic injuries of the spinal column were treated in the period from 2010 to 2023. The entire 14-year period was divided into 2 stages, taking into account the model of care provided to these patients. Stage 1 (2010–2016) included supervision of patients with spinal injuries by pediatric traumatologists-orthopedists and neurosurgeons with a decision on the advisability and timing of specialized treatment with involvement of a spine surgeon from the adult regional hospital to perform the operation. Stage 2 (2017–2023) included total supervision of patients with spinal injuries by specialists from the adult vertebrology department with a decision on the advisability, timing and scope of surgical intervention that would be performed in an adult hospital. The analysis included the number of patients, their epidemiological characteristics, types and location of spinal injury, timing of surgical care, as well as the tactics of surgical treatment taking into account two time stages of care.
Results. In 2010–2016, 22 children and adolescents with spinal injuries were operated on, of which 15 (68.2 %) suffered from neurological deficit. In 2017–2023, 95 victims underwent surgical treatment, of which 28 (29.4 %) had neurological deficit. After changing the concept of determining the grounds for surgical treatment and routing of victims (2017), a disproportionate increase in their total number (22 versus 95) and the number of victims with complicated spinal fractures (15 versus 28) was noted. In total, the number of children and adolescents hospitalized for surgical treatment in the periods under review increased more than 4-fold (by 332.0 %), and the number of complicated spinal injuries increased less than 2-fold (86.7 %).
Conclusion. Centralization of specialized medical care for children with spinal injuries in a functioning spinal surgery department of an adult hospital with the appropriate material and technical base, including instrumentation for children of all age groups, and the routine use of various surgical techniques ensures a unified approach to the principles of diagnosis and treatment of this category of patients with the achievement of good results.

1. Sık N, Bulut SK, Salbas OY, Yılmaz D, Duman M. Evaluation of traumatic spinal injuries: a pediatric perspective. Childs Nerv Syst. 2024;40:2775–2780. DOI: 10.1007/s00381-024-06447-z

2. Mendoza-Lattes S, Besomi J, O’Sullivan C, Ries Z, Gnanapradeep G, Nash R, Gao Y, Weinstein S. Pediatric spine trauma in the United States — analysis of the HCUP kid’s Inpatient Database (KID) 1997–2009. Iowa Orthop J. 2015;35:135–139.

3. Баиндурашвили А.Г., Виссарионов С.В., Павлов И.В., Кокушин Д.Н., Леин Г.А. Консервативное лечение детей с компрессионными переломами позвонков грудной и поясничной локализации в Российской Федерации (обзор литературы) // Ортопедия, травматология и восстановительная хирургия детского возраста. 2016. Т. 4, № 1. С. 48–56. [Baindurashvili AG, Vissarionov SV, Pavlov IV, Kokushin DN, Lein GA. Conservative treatment of children with vertebral compression fractures of the thoracic and lumbar spine in the Russian Federation: a literature review. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2026;4(1):48–56]. DOI: 10.17816/PTORS4148-56

4. Lambrechts MJ, Schroeder GD, Tran K, Li S, Huang A, Chu J, Karamian BA, Canseco JA, Hilibrand AS, Oner C, Dvorak M, Schnake K, Kepler CK, Vaccaro AR. Validation of the AO Spine thoracolumbar injury classification system treatment algorithm: should it be used to guide fracture management? Spine. 2023;48:994–1002. DOI: 10.1097/BRS.0000000000004693

5. Виссарионов С.В., Мушкин А.Ю., Белянчиков С.М. Алгоритм диагностики и тактики хирургического лечения неосложненных повреждений грудного и поясничного отделов позвоночника у детей: метод. рекоменд. СПб., 2007. [Vissarionov SV, Mushkin AYu, Belyanchikov SM. Algorithm for diagnostics and tactics of surgical treatment of uncomplicated injuries of the thoracic and lumbar spine in children: guideline. St. Petersburg, 2007].

6. Афаунов А.А., Кузьменко А.В., Басанкин И.В. Дифференцированный подход к лечению больных с травматическими стенозами позвоночного канала на нижнегрудном и поясничном уровне // Инновационная медицина Кубани. 2016. № 2. С. 5–16. [Afaunov AA, Kuzmenko AV, Basankin IV. Differentiated treatment in patients with traumatic vertebral canal stenosis at lower thoracic and lumbar levels. Innovative Medicine of Kuban. 2016;(2):5–16].

7. Перхов В.И. Пятилетняя динамика основных показателей работы нейрохирургической службы Российской Федерации // Проблемы социальной гигиены, здравоохранения и истории медицины. 2021. Т. 29, № 5. С. 1186–1193. [Perkhov VI. The five-year dynamics of main indices of functioning of neurosurgical service of the Russian Federation. Problems of Social Hygiene, Public Health and History of Medicine. 2021;29(5):1186–1193]. DOI: 10.32687/0869-866X-2021-29-5-1186-1193

8. Порханов В.А., Басанкин И.В., Афаунов А.А., Кузьменко А.В., Гюльзатян А.А. Пути оптимизации оказания вертебрологической помощи в крупном регионе Российской Федерации // Хирургия позвоночника. 2020. Т. 17, № 4. С. 94–101. [Porkhanov VA, Basankin IV, Afaunov AA, Kuzmenko AV, Giulzatyan AA. Ways to optimize providing of spine healthcare in a large region of the Russian Federation. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2020;17(4):94-101]. DOI: 10.14531/ss2020.4.94-101

9. Баиндурашвили А.Г., Виссарионов С.В., Кокушин Д.Н., Белянчиков С.М., Снищук В.П., Картавенко К.А., Залетина А.В. Организация хирургической помощи детям с нестабильными и осложненными переломами позвоночника в условиях мегаполиса // Новые технологии в травматологии и ортопедии детского возраста: сборник научных статей, посвященный 125-летию Научно-исследовательского детского ортопедического института имени Г.И. Турнера. СПб., 2017. С. 41–46. [Baindurashvili AG, Vissarionov SV, Kokushin DN, Belyanchikov SM, Snishchuk VP, Kartavenko KA, Zaletina AV. Organization of surgical care for children with unstable and complicated spinal fractures in a metropolis. In: New Technologies in Pediatric Traumatology and Orthopedics: a collection of scientific articles dedicated to the 125th anniversary of the Turner Research Institute for Children’s Orthopedic. St. Petersburg, 2017:41–46].

10. Chung NS, Lee HD, Park KH, Lee JW, Chung HW. Pediatric spinal trauma at a single level 1 trauma center: review of 62 cases. Clin Orthop Surg. 2023;15:888–893. DOI: 10.4055/cios23118

11. Афаунов А.А., Кузьменко А.В. Басанкин И.В., Агеев М.Ю. К вопросу о классификации посттравматических деформаций грудного и поясничного отделов позвоночника // Хирургия позвоночника. 2018. Т. 15, № 2. С. 23–32. [Afaunov AA, Kuzmenko AV, Basankin IV, Ageev MYu. Classification of post-traumatic deformities of the thoracic and lumbar spine. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2018;15(2):23–32]. DOI: 10.14531/ss2018.2.23-32

12. Пшениснов К.В., Александрович Ю.С., Липин А.С., Тихова Г.П., Миронов П.И., Блинов С.А., Евграфов В.А., Ироносов В.Е., Казиахмедов В.А., Кондин А.Н., Кузьмин О.В., Попова И.Н., Суханов Ю.В., Александрович И.В., Потапов В.С. Предикторы исхода политравмы у детей в первые сутки лечения в ОРИТ // Вестник анестезиологии и реаниматологии. 2024;21(5):66–76. [Pshenisnov KV, Aleksandrovich YuS, Lipin AS, Tihova GP, Mironov PI, Blinov SA, Evgrafov VA, Ironosov VE, Kaziakhmedov VA, Kondin AN, Kuzmin OV, Popova IN, Suchanov YuV, Aleksandrovich IV, Potapov VS. Predictors of polytrauma outcome in children on the first day of treatment in ICU. Messenger of Anesthesiology and Resuscitation. 2024;21(5):66–76]. DOI: 10.24884/2078-5658-2024-21-5-66-76

13. De Los Ríos-Pérez A, García AF, Gomez P, Arias JJ, Fandiño-Losada A. Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma center. Front Pediatr. 2024;12:1481467. DOI: 10.3389/fped.2024.1481467

14. Evans M, Rajasekaran K, Murala A, Moreira A. Development and validation of a pediatric model predicting trauma-related mortality. BMC Pediatr. 2023;23:637. DOI: 10.1186/s12887-023-04437-9

15. Deleon A, Murala A, Decker I, Rajasekaran K, Moreira A. Machine learning-based prediction of mortality in pediatric trauma patients. Front Pediatr. 2025;13:1522845. DOI: 10.3389/fped.2025.1522845

16. Fehlings MG, Hachem LD, Tetreault LA, Skelly AC, Dettori JR, Brodt ED, Stabler-Morris S, Redick BJ, Evaniew N, Martin AR, Davies B, Farahbakhsh F, Guest JD, Graves D, Korupolu R, McKenna SL, Kwon BK. Timing of decompressive surgery in patients with acute spinal cord injury: systematic review update. Global Spine J. 2024;14(3_suppl):38S–57S. DOI: 10.1177/21925682231197404