Our sweet granddaughter (who is only 8 years old) was in a car accident. Because she wasn’t properly restrained in the back seat of the van (she is too little for the shoulder harness), the force of the impact fractured her spine. She has what’s called a Chance fracture. Right now she’s paralyzed from the waist down. They say this might resolve but they are being very low key about making any predictions. What are her chances for recovery?

As you have now discovered, children are at risk for Chance spinal fractures when they are not properly restrained or only partially restrained with seatbelts. Chance fractures are described as flexion-distraction fractures. They occur in the thoracic (mid) spine most often in children. The same type of fracture can occur in adults but usually affects the lumbar spine (low back).

Chance fractures are also referred to as a traumatic horizontal splitting of the spine. The force of the impact throws the child’s weight forward against the seatbelt. The vertebral bone splits in half from side-to-side. The split goes through the main body of the vertebral bone and extends all the way back through the spinouts process (that’s the bump you feel along the back of your spine).

Like your granddaughter, there are often other injuries that occur along with the Chance fracture. These associated injuries include abdominal injury (the “seat belt sign”) and neurologic (nerve) damage. The risk of damaging the spinal cord (creating significant neurologic problems) is very real. This is because the underdeveloped bones and spinal ligaments stretch easily but the spinal cord does not.In accidents like these, there can also be other fractures and head injuries.

According to a recent study of Chance fractures in children, neurologic complications are permanent in about half of all cases. Other studies have suggested a slightly lower percentage (30 per cent) of neurologic injuries are permanent. Neurologic complications can refer to a wide range of symptoms and severity. Paralysis is the more extreme end of the spectrum. Children who weren’t seatbelted in at all seem to be the most likely to suffer permanent injury.