Fortunately, spinal cord injuries are not that common in children. They only make up between one and ten percent of all spinal cord injuries. That comes to about 1000 incidences per year.
When they do occur, however, they can be the worst kind of tragedy. “For this reason”, says Dr. Richard Anderson from The Spine Hospital at the Neurological Institute of New York, “it is important to understand the typical mechanisms of injury in children and their special treatment needs.”
In children under 8 years old, spinal cord injuries are most often located in the cervical spine (the neck region). This is because of the unique anatomy and biomechanics of children in this age group. They usually have a disproportionately large head, underdeveloped neck musculature, and a much more flexible spinal column. This has to do with the shapes of the bones and an increase in flexibility of the joints. (For more information about this, see our blog: Pediatric Spine: Not Just Smaller- Different.)
The increased flexibility in their spinal column does not proportionately apply to their spinal cord, however. According to Dr. Anderson, “While the column has 2 inches of play, the cord has a mere quarter inch.” This means that in an accident, the spinal column can be thrust in one or more directions that exceed the flexibility of the cord resulting in grave injury.
Spinal cord injury itself happens in two phases. The first is the irrevocable force that actually injures the spinal cord. The second is what happens afterward. While the original injury can’t be undone, doctors do have some control over how a child survives the second phase.
Immediately after injury, the child’s spine must be stabilized to prevent any further mechanical injury from an unstable spine, or the possibility of loose bone fragments. The injury itself will also trigger a complex cascade of events throughout many systems within the body that can cause further damage.
Among these are severe inflammation, shock, and changes in the immune system. Physicians can use a number of medications and other therapies to mitigate these effects and they need to be sensitive to the dosage requirements specific to children.
An X-Ray needs to be taken as soon as possible to begin to determine the extent of the injury. Dr. Anderson emphasizes, that there can be a spinal cord injury present even when X-Rays appear normal. He urges that if a physician suspects injury based on their examination, then dynamic imaging studies, a CT scan, or MRI should be performed.
He recommends further, that if any instability is discovered, then surgery should be considered regardless of whether the cord has sustained any injury. This is because an unstable spinal column is extremely dangerous and poses a continued risk until it is stabilized.
The surgical procedures performed on children need to take not only their smaller size into consideration but also their unique biomechanics too. Dr. Anderson says, “Thorough preoperative planning is critical.”
The continued growth of young children is a large consideration both in planning surgery and in how long the child should be followed afterward. Surgeons may often opt for less instrumentation placed inside the body and greater external bracing to allow for continued growth and to maximize the exceptional healing potential that children have. Dr. Anderson recommends at least yearly follow-up until the child is fully grown.
Image Credit: spotmatikphoto / Adobe Images
Originally Published Aug 2, 2010
Updated on January 4, 2017