Introduction
In children, spinal cord injuries (SCIs) pose distinct challenges for medical professionals and families. These injuries profoundly impact a child's health and daily life. Pediatric spinal cord injuries are rare, accounting for less than 4% of all SCIs annually.
How Does Children’s Spinal Cord Differ From That of an Adult?
Children's spinal cords and injuries differ from adults because their bodies are structured and still growing and maturing. Kids have more bones in their backbone, called vertebrae than grown-ups because some stick together as they age. Their neck has a moving center point, which leads to more frequent injuries in the upper part of their neck.
Children's spines are bendier than adults, with more fluid and less tight ligaments in their spines. Also, children may have bones that are not fully developed, like the bone in the neck called the odontoid process, and weaker muscles in their neck. This makes them more likely to have problems with their spine being unstable. Their injuries to the spinal cord can have different effects because their central nervous system is still developing, which can result in different levels of functioning compared to adults.
What Are the Causes of Pediatric Spinal Cord Injury?
Pediatric SCIs have different causes compared to adult SCIs.
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Non-traumatic Causes - Common causes in children include congenital anomalies, infections, spinal cord tumors, and vascular malformations.
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Traumatic Causes - Traumatic SCIs result from direct mechanical injury to the spinal cord, leading to permanent motor deficits, sensory impairments, and more. Traumatic causes include falls, sports injuries, motor vehicle accidents, and child abuse. Motor vehicle accidents and sports injuries are the leading causes of SCIs in young children and adolescents, with a higher prevalence in males.
What Are the Signs and Symptoms of Pediatric Spinal Cord Injury?
Symptoms of spinal cord injury in children may vary depending on the injury. Some of the symptoms that may occur are listed below.
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Paralysis in various parts of the body depends on the injury level.
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Difficulty with small movements and coordination.
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Numbness or loss of sensation in specific body areas.
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Altered perception of pain, temperature, or touch.
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Absent or diminished reflexes.
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Intense pain at the site of the injury or radiating to other areas.
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Neuropathic pain is characterized by burning or tingling sensations.
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Difficulty breathing.
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Weak cough or inability to clear secretions.
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Not being able to control their bowel and bladder movements.
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Impaired sexual function in older children and adolescents.
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Muscle spasms and involuntary contractions.
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Muscle stiffness and hypertonia.
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Blood pressure and heart rate abnormalities.
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Temperature regulation issues (sensitivity to heat or cold).
Other Complications:
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Pressure sores (bedsores).
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Contractures (permanent joint stiffness).
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Emotional distress, depression, and anxiety.
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Behavioral changes in response to the injury.
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Challenges with mobility, dressing, grooming, and feeding.
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Dependence on assistive devices, wheelchairs, or other aids.
How Are Pediatric Spinal Cord Injuries Diagnosed?
Getting timely evaluations from healthcare professionals is important. They will look at how the child is feeling, find any problems they are having, and check their body for signs of SCI.
Some of the common points to consider while diagnosing include the following.
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Quickly evaluating the injury is important to understand its seriousness and determine the best way to help.
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Initial X-rays can provide a quick spine overview, indicating potential fractures or dislocations.
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It is vital to identify the injuries, but imaging methods that expose kids to radiation should be used cautiously.
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Due to smaller bodies in children, they are most vulnerable to radiation. Therefore, radiation should be used as little as possible during CT scans.
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For neck injuries, criteria like NEXUS (National Emergency X-radiography Utilization Study) are used to decide if imaging like X-rays or CT scans is needed. It is based on factors like neurological symptoms, pain, and injury type.
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Things like how the injury happened and the child's age is also considered. More advanced scans like MRI may be used for younger kids and severe injuries.
What Is SCIWORA?
SCIWORA, or Spinal Cord Injury Without Radiographic Abnormality, is a condition where there is a spinal cord injury without any apparent abnormalities visible on standard X-ray or CT scans. It is often observed in pediatric patients, and the absence of radiographic evidence can lead to delayed diagnosis and treatment. Magnetic resonance imaging (MRI) is a crucial diagnostic tool for detecting SCIWORA, as it can reveal subtle spinal cord injuries that conventional imaging may miss.
How Are Pediatric Spinal Cord Injuries Managed?
Pediatric SCI is classified using the ASIA (American Spinal Injury Association) Impairment Scale. This classification helps determine the extent of injury, with various levels and grades indicating different degrees of impairment and potential for recovery.
The treatment options for pediatric SCI are listed below.
Emergency Care
Immediate medical attention is crucial to stabilize the child's condition and prevent further damage to the spinal cord. This may involve immobilization and monitoring for complications.
Initial management follows Advanced Trauma Life Support (ATLS) principles, focusing on airway, breathing, and circulation.
Non-surgical Interventions
Conservative management is often preferred, considering a child's anticipated growth and anatomical changes that surgery may impede. This includes non-surgical methods, physical therapy, and rehabilitation. Steroids may be considered within 8 hours of injury in pediatric acute hyperextension SCIs. Patients with SCIs can experience shock. Neurogenic shock may require vasoactive support, and maintaining age-appropriate blood pressure is recommended.
Surgical Interventions
Although guidelines are limited in the pediatric population, early surgery (within 24 hours of injury) is suggested for adults with acute SCIs.
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Decompression Surgery: In cases where the spinal cord is under pressure due to bone fragments or swelling, surgery may be required to relieve this pressure.
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Fusion Surgery: Stabilization surgery may be necessary to prevent further injury and facilitate healing. The timing of these surgical interventions is often very important.
Rehabilitation
Rehabilitating pediatric spinal cord injuries (SCIs) is a comprehensive process focusing on mental, physical, and social well-being. Mental health issues like depression are less prevalent in pediatric cases, with older adolescents being more affected. Proper management is crucial for addressing various health problems, including cardiovascular and skin conditions. Orthopedic approaches like braces and assistive devices help those with mobility impairments. Children with SCI may require assistive devices, such as wheelchairs, braces, or orthotics, to enhance their mobility. Communication aids can also be vital for children with severe SCI, enabling them to interact effectively with others.
Conclusion
Research has led to many recent advances in spinal cord injury, providing hope for neural recovery and functional restoration. These approaches can be categorized into neuroprotective strategies, neuro regenerative therapies, and biomaterial scaffolds. These treatments offer hope for improved outcomes and functional recovery in pediatric SCI patients, with ongoing research and clinical trials to validate their effectiveness.
