Long-term outcome of paediatric spinal cord injury

Abstract

Background: Spinal cord injuries are relatively uncommon in children and evidence about long-term outcomes is limited. This study was performed to determine the frequency of common long-term complications in patients sustaining spinal injury in childhood (0-18 years) and who were followed up at a single dedicated spinal injuries centre in the UK. Method: A retrospective review of clinical records of all patients injured at or less than 18 years of age between 1971 and 1999. Complications studied were renal, bowel, musculoskeletal, pressure ulcers and post-traumatic syringomyelia. Long-term social outcomes of independence, employment and driving were also assessed. Results: Of 69 individuals (47 males, 22 females) the median age at injury was 17 years (range 0-18 y); 68% were older than 13 years at injury and 74% had traumatic injuries. Patients had an average duration of 27 years (12-43 years) of spinal injury-half had a neurological level of T6 and above, 80% had paraplegia and 20% had quadriplegia. Discussion: Patients with both complete and incomplete spinal cord injury have minimal neurological recovery. Managing medical complications is vital as only 11.5% had normal voiding and 10.6% had normal bowel function. The incidence of skin ulcers increases with duration of spinal cord injury and scoliosis is higher in the non-traumatic injury group. Spasticity is observed in 66.6% and post-traumatic syringomyelia in 11.7%. Long-term social outcomes are good with 75% patients able to do independent care, 46% could drive and 39% managed employment or higher education. Conclusions: This study documents the long-term outcomes and complications of spinal cord injuries sustained in childhood. With initial active physiological conservative management of the majority of patients, patient education and ongoing support the majority of patients achieved long-term survival and led independent and productive lives.

Traumatic Spinal Cord Injury in Children: Clinical Profile and Management Outcome in a Developing Country's Rural Neurosurgery Practice

“…Road traffic accident is the usually reported leading cause of pediatric traumatic SCI in developed countries, while fall was once deemed to be the leading cause in some of the less developed countries. 16,22,25,26,37 Road traffic accident is, however, the most common cause of traumatic SCI in this study similar to what is being widely reported in the literature. Even so, certain characteristics of this mechanism of injury (road trauma) differ in our study cohort from what was previously documented.…”

“…22,25,26,37 However, the mean age of our patients is lower than previously indicated. 22,25,26,37 There are proportionately more patients (30.0%) below the age of 10 years in our study than was previously documented, 16,22 while another 4 of our patients (20.0%) were younger adolescents (aged 10-12 years) (Fig. 1).…”

“…This proportion is at variance with the reported high rates of complete and varying degree of incomplete injuries although Falavigna et al also reported a high rate of neurologically intact patients in their series. 16,22,25,26,43 The plain radiograph of the spine, despite its limitations, was the only radiologic investigation in 90% of our patients. In six (30%) of our patients, no abnormality was seen on this investigative modality (Spinal cord injury without radiographic abnormality; ►Table 3).…”

“…The male predominance observed in this study has been widely reported too. 13,16,22,25,26,37 This higher male incidence has been attributed to the fact that male children are more likely, in the more affluent environment where those studies emanated, to be involved in contact sports or to own and drive a car than the female peers. 37 In our own low-resource developing country setting, however, the male cohort just happened to be the more economically mobile, more daring, and more prone to injuries than their female counterparts.…”

“…[10][11][12][13][14][15] In this age group, traumatic SCI presents a different set of challenges compared with the adults because of the immaturity of their body systems, as well as their ongoing physical, psychological, social, and intellectual development. [16][17][18][19][20][21] Matter of fact, there is some evidence showing that traumatic SCI in children has a different epidemiology and, perhaps, a better potential for recovery compared with the adult population. 13,22,23 Robust epidemiologic data on pediatric traumatic SCI are, therefore, required to identify the groups at risk, develop prevention program, as well as plan resource allocation, care, and rehabilitation to achieve the optimal functional outcome.…”