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Spinal Cord Injury in Children

By James E. Wilberger, MD, Professor of Neurosurgery;Jannetta Endowed Chair, Department of Neurosurgery;DIO, Chairman Graduate Medical Education Committee;Vice-President, Graduate Medical Education, Drexel University College of Medicine;Allegheny General Hospital;Allegheny Health Network Medical Education Consortium;Allegheny Health Network ; Gordon Mao, MD, PGY 5 Neorosurgery Resident, Allegheny Health Network

Although children younger than 10 years have the lowest rate of spinal cord injuries, such injuries are not rare. Most spinal injuries in children occur in the neck area.

In children younger than 8 years, neck spinal injuries are most commonly caused by motor vehicle crashes, falls, and child abuse. In children older than 8 years, motor vehicle crashes and sports injuries, particularly injuries due to gymnastics, diving, horseback riding, American football, and wrestling, are common causes of spine injuries. Compared with adults, children have distinct anatomic features (such as larger head size-to-body and elasticity of spinal ligaments) that make the structures protecting the spinal cord (including the vertebrae) more flexible. Because these structures are so flexible, the spinal cord can be less protected from being stretched, torn, compressed, or otherwise damaged when the neck is injured. Thus, the spinal cord can be more likely to be damaged even when the vertebrae are not damaged.

Children with spinal cord injury may have brief symptoms such as tingling and weakness. Children may also have shooting pains down the spine or the arms or legs. In about 25% of affected children, onset of symptoms, such as weakness, numbness, other nerve damage, or even complete paralysis, is delayed from 30 minutes to 4 days after injury, making it more difficult for doctors to diagnose spinal cord injury.

Spinal cord injury that is not seen on imaging is related to pulling or stretching of the spinal cord, pressure on the nerves or spinal cord (spinal cord impingement), spinal cord concussion (similar to a brain concussion), and injury to the blood vessels. Injury that is not visible on imaging tests is called "spinal cord injury without radiologic abnormality." This type of injury occurs almost exclusively in children and often occurs in the neck area. In spinal cord injury without evidence of radiologic abnormality, the child has symptoms that suggest a spinal cord injury, but the spinal column is straight and no bone abnormalities are seen on imaging studies.

Diagnosis

  • X-rays

  • Usually computed tomography and magnetic resonance imaging

Doctors suspect spinal cord injury in any child who has been in a motor vehicle crash, has fallen from a height greater than about 9 feet (3 meters), or has had a submersion (for example, diving) injury.

Imaging usually begins with x-rays. If a fracture, dislocation, or partial dislocation is suspected based on x-ray findings or because of the way the injury occurred, computed tomography (CT) is usually done. Magnetic resonance imaging (MRI) is usually also done.

Sometimes a spinal cord injury may not be seen on imaging tests.

Treatment

  • Immobilization

  • Supportive care

  • Rehabilitation

Children with a spinal injury should be transferred to a pediatric trauma center.

Treatment is similar to that in adults, including immobilization and support for breathing and circulation as needed.

Long-term rehabilitation and other treatment are needed.