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CHAPTER
44
Spinal Fractures, Spondylolysis and
Spondylolysthesis
Paul W. Esposito
1
and Vincent Arlet
2
1
University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, NE, USA,
2
University of Pennsylvania, Philadelphia, Pennsylvania, PA, USA
INTRODUCTION
The most striking finding in researching and writ-
ing this chapter is the paucity of literature related to
the etiology, treatment and long-term outcome follow-
ing spinal fractures in OI. There is mention of kyphosis,
and many of the articles on scoliosis mention this only
in passing, noting that in most individuals with both OI
and scoliosis, there is associated kyphosis rather than
the more typical thoracic lordotic posture seen in idio-
pathic scoliosis.
1-4,10
The development of compression fractures can be
insidious with multiple recurrent subtle “microfractures”
or acute and significantly symptomatic fractures with
clear-cut radiologic findings. The degree of discomfort
the individual experiences can be significant, and is fre-
quently related to the severity of the acute compression
and loss of vertebral height. However, this has not been
quantified or studied to any great extent. The authors
are aware of individuals with acute neurologic injuries
occurring with relatively mild trauma. Paraplegia after
chiropractic manipulation was reported in an adolescent
secondary to anterior cervical compression.
11
There have
also been reports of individuals presenting initially with
vertebral fractures who had not previously been diag-
nosed with OI.
12,13
Multiple level spinal fractures have
also been described.
14
These reports demonstrate that
fractures can occur with minimal trauma in these pre-
disposed individuals. However, there is no significant
study with a large number of patients to be able to make
a determination of appropriate treatment and prognosis.
The occurrence of multiple level compressed ver-
tebrae is more common in individuals with the more
severe forms of OI.
13,14
Individuals with type I OI tend to
have fewer levels involved than those with more severe
Spine fractures in osteogenesis imperfecta (OI) are
well recognized as a major problem, and can contrib-
ute to sagittal spinal deformity as well as scoliosis.
1-4
However, there is a paucity of literature related to the
incidence, and especially the assessment and treatment,
of vertebral body fractures, as well as the long-term
sequelae of these fractures. Historically, if a significant
injury occurred to the vertebral body causing anterior
compression and deformity rarely, if ever, would this
deformity remodel and improve over time. In clini-
cal practice now, as well as demonstrated in published
studies, it is quite common to see a significant improve-
ment in the height of compressed vertebral bodies
over time, at least in infants and young children being
treated with i.v. pamidronate who sustain significant
flexion injuries.
5-8
However, there are many questions
remaining related to how the modern medical manage-
ment of children with OI will affect spinal development
and function in the long-term that deserves more study.
The incidence and severity of spine fractures and
secondary sagittal spinal deformity in OI appears to be
less with bisphosphonate treatment in clinical practice
although long-term studies on this topic have not been
published. In multiple studies, reconstitution of ver-
tebral deformities have been demonstrated in children
treated in infancy with IV pamidronate (
Figure 44.1
).
6-9
Paradoxically, the majority of children with all types
of OI are more functional with this medical manage-
ment and are therefore more active, potentially increas-
ing their risk of spine fractures and the development of
spondylolysis and/or spondylolisthesis.
