Paediatric Spinal Cord Injury

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Introduction[edit | edit source]

A spinal cord injury (SCI) is when the spinal cord is damaged from an accident or other situation. Pediatric traumatic spinal cord injury (SCI) is an uncommon presentation accounting for a mere 5%. The mechanism of injury, the male: female ratio, and the level of injury all differ from adult SCI. The rate of recovery following SCI in the pediatric population is also thought to be faster mainly because of the anatomical differences with adults along with the inherent elasticity of the pediatric spine.[1]

The typical injuries occurring in children include occipito-atlantal or atlanto-axial dissociation, atlanto-axial rotary subluxation, spinal cord injury without radiological abnormality, and multiple thoracic compression fracture[2].

Congenital and acquired pediatric spinal cord injuries (SCI) pose unique management challenges because of the dynamic nature of cognitive and physical development in the growing child and the impact of the SCI on this complex process[3].

Epidemiology/Etiology[edit | edit source]

Epidemiology[edit | edit source]

In pediatric patients, Traumatic SCI is relatively rare, with:

  1. only about 2% to 5% being spine injuries [4]
  2. >80% of injuries occurring in the cervical spine, while the percentage of cervical regions in adults is only around 30% to 40% [5].
  3. thoracic and lumbar spine injuries representing 6% to 9% of all pediatric spine trauma[6]
  4. decreased cervical injuries incidence after age 14 with a resemblance adult patient pattern[7]

With respect to the mechanism of injury:

  1. Motor vehicle accidents caused SCI in smaller children
  2. Sports were responsible for adolescent SCI injuries[8].

Etiology[edit | edit source]

  1. motor vehicle crashes,
  2. violence and sports.
  3. trauma resulting from lap belt injuries, child abuse, and birth injuries; and
  4. nontraumatic causes, such as instability of the upper cervical spine seen in Down syndrome, spinal stenosis seen in skeletal dysplasias, and inflammatory conditions, such as juvenile rheumatoid arthritis.
  5. the phenomenon of SCI without radiographic abnormality (SCIWORA).[3]

Clinical presentation[edit | edit source]

The clinical presentation of a Paediatric SCI will depend on the degree of severity and particular location of their injury.[3]

Some of them may be:

  1. spinal shock — a pronounced loss of feeling, muscle movement, and reflexes below the level of her injury.
  2. muscle weakness
  3. partial or complete loss of muscle movement in the chest, arms, or legs
  4. breathing difficulty
  5. partial or complete loss of feeling in the chest, arms, or legs
  6. loss of bowel and bladder function

In general, the higher in the back or neck the injury is located, the more extensive the symptoms will be. For example, if the injury is in the lower portion of the spinal column, there may be reduced or absent feeling in (and impaired control of) the legs, bladder, and bowels. If the SCI is in the upper neck region, they may be unable to move her arms or legs or to breathe on her own.

SCIs can be severe and potentially life-threatening injuries and as a rule of thumb, in all children admitted with head injury or unconsciousness, spinal injury has to be ruled out[2].

Differential Diagnosis[edit | edit source]

Imaging and Outcome Measures[edit | edit source]

Imaging[edit | edit source]

  • Blood tests.
  • X-ray.
  • CT scan.
  • MRI: helpful to reveal ligamentous or disk injury and of course show the neural elements in great details and useful information in cases of SCI especially with regards to prognosis depending on the extent of signal intensity changes of the cord. [2][9]

Outcome measures[edit | edit source]

The outcome measures that can be used in assessing the Paediatric SCI are:

  1. Paediatric Glasgow Coma Scale
  2. Pediatric Neuromuscular Recovery Scale : a capacity-based measure for use in the context of assessing change relative to neurotherapeutic interventions[10]
  3. Functional Independence Measure (FIM) [11]

Other outcome measures can be found here.

Medical Management[edit | edit source]

Physiotherapy management[edit | edit source]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Parent S, Mac-Thiong JM, Roy-Beaudry M, Sosa JF, Labelle H. Spinal cord injury in the pediatric population: a systematic review of the literature. J Neurotrauma. 2011 Aug;28(8):1515-24. doi: 10.1089/neu.2009.1153. Epub 2011 Jun 9. PMID: 21501096; PMCID: PMC3143390.
  2. ↑ 2.0 2.1 2.2 Basu S (2012) Spinal injuries in children. Front. Neur. 3:96. doi: 10.3389/fneur.2012.00096
  3. ↑ 3.0 3.1 3.2 Powell A, Davidson L. Pediatric Spinal Cord Injury. A Review By Organ System. Phy. Med. and Rehab Clinics, 2015; 26(1); 109-132. DOI:https://doi.org/10.1016/j.pmr.2014.09.002
  4. ↑ Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN. Spinal injuries in children. J Pediatr Surg. 2004;39(4):607–12.
  5. ↑ Eubanks JD, Gilmore A, Bess S, Cooperman DR. Clearing the pediatric cervical spine following injury. J Am Acad Orthop Surg. 2006;14(9):552–64.
  6. ↑ Garg H, Pahys J, Cahill PJ. Thoracic and Lumbar Spine Injuries. InPediatric Orthopedic Surgical Emergencies 2012 (pp. 67–86). Springer, New York, NY.
  7. ↑ Hall DE, Boydston W. Pediatric neck injuries. Pediatr Rev. 1999;20(1):13–9.
  8. ↑ Brown R.L. Brunn M.A. Garcia V.F. Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J. Pediatr. Surg. 2001;36:1107–1114.
  9. ↑ Benmelouka A, Shamseldin LS, Nourelden AZ, Negida A. A Review on the Etiology and Management of Pediatric Traumatic Spinal Cord Injuries. Adv J Emerg Med. 2019 Oct 10;4(2):e28. doi: 10.22114/ajem.v0i0.256. PMID: 32322796; PMCID: PMC7163256.
  10. ↑ Behrman AL, Trimble SA, Argetsinger LC, Roberts MT, Mulcahey MJ, Clayton L, Gregg ME, Lorenz D, Ardolino EM. Interrater Reliability of the Pediatric Neuromuscular Recovery Scale for Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2019 Spring;25(2):121-131. doi: 10.1310/sci2502-121. PMID: 31068744; PMCID: PMC6496963.
  11. ↑ Allen DD, Mulcahey MJ, Haley SM, Devivo MJ, Vogel LC, McDonald C, Duffy T, Betz RR. Motor scores on the functional independence measure after pediatric spinal cord injury. Spinal Cord. 2009 Mar;47(3):213-7. doi: 10.1038/sc.2008.94. Epub 2008 Aug 5. PMID: 18679405; PMCID: PMC2718680.
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