Minimal kyphotic progression following pediatric vertebral fractures: implications for reduced radiographic surveillance

INTRODUCTION: Pediatric spinal fractures are rare injuries (14.24 per 100,000 per year), representing only 0.6-3% of all spinal injuries. While most stable compression fractures are managed conservatively, concerns exist regarding progressive vertebral collapse and kyphotic deformity. Unlike extensive adult literature, pediatric-specific data on radiographic progression following conservative management remain limited, creating uncertainty about the clinical utility of routine follow-up imaging in this radiosensitive population. MATERIALS AND METHODS: Retrospective single-centre cohort study of 54 pediatric patients (mean age 12.3 years) with traumatic vertebral body fractures diagnosed between 2012 and 2024. Kyphosis angles were measured using Cobb methodology at baseline and follow-up intervals (1, 3, and 6 weeks). The primary outcome was the change in kyphotic angle; secondary outcomes included the identification of predictors of progression. Paired t-tests and multivariable linear regression analysis were performed. RESULTS: Kyphosis angles remained essentially unchanged across all follow-up intervals (ΔFU1 + 0.19°, ΔFU2 + 1.27°, ΔFU3 - 0.14°), with no statistically significant differences detected (p > 0.05 at all timepoints). No clinical or radiographic factors predicted progression of kyphosis. Only three patients (5.6%) required treatment escalation. Subgroup analyses revealed no significant differences across fracture types, treatment modality, or injury characteristics. CONCLUSION: Pediatric patients with stable compression fractures demonstrate minimal kyphotic progression regardless of treatment approach. Routine radiographic surveillance provides little clinical value and exposes children to unnecessary ionising radiation. The present study suggests that routine radiographic follow-up may not be necessary in carefully selected patients with stable vertebral compression fractures who remain clinically asymptomatic. Nevertheless, these findings should be interpreted in light of the retrospective study design and the limited sample size. Confirmation in larger prospective studies is needed before changes to routine follow-up protocols can be recommended.