Anterior wedge compression can often be managed with external orthosis alone. The presence of neurological deficit, instability, progressive deformity, greater than 30% kyphosis and/or >50% vertebral-body height loss may require operative intervention. Adolescents are candidates for adult-type instrumentation in most cases. In younger children, the pedicles are often too small for screw fixation, although frameless stereotactic guidance is sometimes helpful in this setting. The spinal canal may also be too small for safe use of sublaminar hooks in these patients. Upper lumbar injuries are often "Chance" fractures, coursing horizontally through the intervertebral disc or superior endplate and posterior elements (see Fig. 9). These fractures, which are commonly caused by wearing a lap seatbelt alone, are often unstable and may be associated with injury to retroperitoneal organs.
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