We are on pins and needles waiting to hear from the neurosurgeon about our son. He was in a van being transported by his day care when they had an accident. He had a seat belt (lap type) fastened but he wasn’t in a car seat and he didn’t have a shoulder strap in place. They are doing surgery to fuse his spine because of a “Chance” fracture (that’s what they called it). How serious is this?

Chance fractures of the spine occur most often as a result of car accidents. Adults and children can be affected. The improper use of restraints (lap belts without a shoulder harness, shoulder harness without the lap belt, or no belt at all) increase the risk of a Chance fracture. Sometimes people move the shoulder harness behind them because it crosses too high across their bodies making it uncomfortable.

Chance fractures are also referred to as a traumatic horizontal splitting of the spine. The force of the impact throws the person’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).

The type of treatment given may make a difference in the final results. Yet, right now there doesn’t appear to be a standard way to approach treatment for Chance fractures. Sometimes surgeons try placing the child in a cast or brace that holds the spine straight or in slight extension.

In other cases (usually in the case of more severe fractures and more forward flexion of the spine), surgery is done to fuse the spine. Rods, hooks, screws, and/or wires are used to hold the spine in good alignment during healing and recovery. Some surgeons suggest that children with a forward-flexed spine (called kyphosis) of more than 20 degrees are more likely to need surgery in order to have a good final outcome.

Further studies are needed to compare the results of different treatment approaches. For example, it’s possible that even one variable (e.g., location of the fracture(s), severity of fracture(s), age of the child, severity of kyphosis, presence of other injuries) could make a difference in selecting the most successful treatment.

The presence of other injuries may be as important as the spinal fracture. Multiple fractures, head injuries, and abdominal damage can complicate the picture. This is a rare type of spinal fracture so large studies are not available. In smaller studies, there are isolated (single cases) of death reported.

There is always a risk of long-term problems with these types of injuries. The neurosurgeon will be able to give you a better idea of what to expect after seeing the exact location and severity of injuries. Most children have a good result meaning no chronic pain and no permanent neurologic problems. We hope your son falls into this category.