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Spinal Cord Injury in Children
Introduction
Although children<10 years have the lowest rate of spinal cord injuries, such injuries are not rare. Most spinal injuries in children occur in the neck. In children<8 years,cervicalspine injuries occur most commonly above C4 and are most commonly caused by motor vehicle crashes, falls, and child abuse. In children>8 years, injuries at C5 to C8 are more common and are due to motor vehicle crashes and sports injuries, particularly gymnastics, diving, horseback riding, American football, and wrestling. Compared with adults, children have distinct anatomic features (eg, larger head size-to-body ratio, elasticity of spinal ligament capsules) that predispose them to hypermobility of the spinal column without apparent bony injury. Children with spinal cord injury may have transient symptoms such as paresthesias and weakness. Children may also have lancinating pains down the spine or extremities. In about 25% of affected children, onset of neurologic signs (such as partial neurologic deficits, complete paralysis) is delayed from 30 minutes to 4 days after injury, making immediate diagnosis difficult. Spinal cord injury without evidence of radiologic abnormality (SCIWORA) is related to direct spinal cord traction, spinal cord impingement, spinal cord concussion, and vascular injury. This type of injury occurs almost exclusively in children and often occurs in the cervical spine. In spinal cord injury without evidence of radiologic abnormality, the patient has neurologic findings suggestive of spinal cord injury (eg, paresthesias, weakness) but normal anatomic alignment, and no bone abnormalities are seen on imaging studies (plain x-rays, CT, and/or MRI). Children immobilized by SCIWORA or other spinal cord injuries are at risk for complications due to immobility, including Pressure Injuries , thromboembolic complications, (See also Spinal Trauma .) 