Spinal Cord Injuries in Children

Topic Name Introduction Initial Assessment Classification and Imaging Acute Management Complications Rehabilitation Prognosis and Outcomes

Introduction to Pediatric Spinal Cord Injury

Epidemiology and Unique Features

• Age Distribution:
  • 0-4 years: Predominantly upper cervical injuries
  • 5-12 years: Mixed patterns
  • 13-17 years: Adult-like patterns
• Common Mechanisms:
  • Motor vehicle accidents (45%)
  • Sports injuries (15%)
  • Falls (14%)
  • Birth trauma (10%)
  • Non-accidental trauma (8%)

Anatomical Considerations

• SCIWORA (Spinal Cord Injury Without Radiographic Abnormality):
  • More common in children <8 years
  • Results from increased elasticity of pediatric spine
  • May have delayed onset of symptoms
• Growth and Development Factors:
  • Large head-to-body ratio in young children
  • Incomplete ossification of vertebrae
  • Horizontal facet joints
  • Ligamentous laxity
  • Weak neck muscles

Initial Assessment

Primary Survey

• Airway and Cervical Spine:
  • Maintain manual in-line stabilization
  • Consider early intubation if respiratory compromise
  • Age-appropriate equipment selection
• Breathing:
  • Assess for diaphragmatic breathing
  • Monitor for respiratory fatigue
  • Check for associated chest injuries
• Circulation:
  • Assess for neurogenic shock
  • Monitor for bradycardia
  • Evaluate peripheral perfusion

Neurological Examination

Component	Key Elements	Special Considerations
Mental Status	AVPU, GCS	Age-appropriate assessment
Motor Function	Strength, Tone, Reflexes	Compare sides, document changes
Sensory Level	Light touch, Pin prick	May be difficult in young children
Autonomic Function	HR, BP, Temperature	Monitor for dysautonomia

Classification and Imaging

ASIA Impairment Scale

• Grade A: Complete - No sensory or motor function preserved
• Grade B: Incomplete - Sensory but not motor function preserved
• Grade C: Incomplete - Motor function preserved below level, majority of key muscles grade <3
• Grade D: Incomplete - Motor function preserved below level, majority of key muscles grade ≥3
• Grade E: Normal - Sensory and motor function normal

Imaging Protocol

• Initial Imaging:
  • Plain radiographs: AP, lateral, odontoid views
  • CT scan for bony detail
  • MRI for ligamentous and cord injury
• Special Considerations:
  • Flexion-extension views when indicated
  • Follow-up imaging at 48-72 hours in SCIWORA
  • Consider whole spine imaging

Common Injury Patterns

• Upper Cervical (C1-C3):
  • Atlanto-occipital dissociation
  • Atlas fractures
  • Odontoid injuries
• Lower Cervical (C4-C7):
  • Compression fractures
  • Facet dislocations
  • Burst fractures

Acute Management

Initial Stabilization

• Immobilization:
  • Age-appropriate collar sizing
  • Log-roll technique
  • Pressure point padding
• Hemodynamic Support:
  • Mean arterial pressure goals
  • Fluid resuscitation
  • Vasopressor selection

Medical Management

• Methylprednisolone Protocol:

  Timing	Dosing	Duration
  <3 hours post-injury	30 mg/kg bolus	24 hours
  3-8 hours post-injury	30 mg/kg bolus	48 hours
  Maintenance	5.4 mg/kg/hr	As per protocol

• Neuroprotection:
  • Temperature management
  • Blood pressure optimization
  • Oxygenation goals

Surgical Considerations

• Indications:
  • Progressive neurological deficit
  • Unstable fractures
  • Significant cord compression
  • Failed conservative management
• Timing:
  • Emergency: Progressive deficit
  • Urgent: Within 24 hours
  • Early: Within 72 hours

Complications

Early Complications

• Respiratory:
  • Atelectasis
  • Pneumonia
  • Respiratory failure
• Cardiovascular:
  • Neurogenic shock
  • Bradyarrhythmias
  • Autonomic dysreflexia
• Other Systems:
  • Pressure injuries
  • Deep vein thrombosis
  • Neurogenic bowel/bladder

Late Complications

• Musculoskeletal:
  • Spasticity
  • Contractures
  • Heterotopic ossification
  • Scoliosis
• Psychological:
  • Depression
  • Anxiety
  • Post-traumatic stress

Rehabilitation

Early Rehabilitation

• Physical Therapy:
  • Range of motion exercises
  • Positioning protocols
  • Respiratory therapy
• Occupational Therapy:
  • Activities of daily living
  • Adaptive equipment
  • Environmental modifications

Long-term Management

• Educational Support:
  • School reintegration
  • Vocational training
  • Social skills development
• Family Support:
  • Caregiver training
  • Psychological support
  • Resource coordination

Prognosis and Outcomes

Prognostic Factors

• Better Prognosis:
  • Incomplete injuries
  • Preservation of sacral function
  • Early recovery of motor function
  • Young age at injury
• Poor Prognosis:
  • Complete injuries at 72 hours
  • High cervical injuries
  • Associated traumatic brain injury
  • Delayed presentation

Long-term Outcomes

• Functional Outcomes:
  • Level-dependent independence
  • Adaptive equipment needs
  • Educational achievement
• Quality of Life:
  • Social integration
  • Emotional adjustment
  • Family dynamics

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.