Spinal cord injuries in young children: a review of children injured at 5 years of age and younger

Abstract

ABBREVIATIONS AISASIA Impairment Scale DVT Deep venous thrombosis SCI Spinal cord injury SCIWORA Spinal cord injury without radiological abnormalities AIM To determine the epidemiology and complications of spinal cord injuries (SCIs) in children injured at 5 years of age and younger who were seen between 1981 and 2008 at a children's hospital in the USA.METHOD Complications studied were scoliosis, hip dysplasia, latex allergies, autonomic dysreflexia, pressure ulcers, spasticity, deep venous thrombosis, and kidney stones. Demographic and injury-related factors included age at injury, etiology, level of injury, American Spinal Injury Association Impairment Scale (AIS), and SCIs without radiological abnormalities (SCIWORA). RESULTSOf the 159 individuals seen (92 males, 67 females) median age at injury was 2 years (range 0y-5y 11mo). Forty-nine percent were injured in vehicular accidents, 60% had complete injuries, 66% had paraplegia, and 72% had SCIWORA. Ninety-six percent developed scoliosis, 57% had hip dysplasia, and 7% had latex allergy. Thirty-four percent with injuries at or above T6 experienced autonomic dysreflexia, 41% developed pressure ulcers, and 61% experienced spasticity. Of those without bowel or bladder control, 82% were on intermittent catheterization and 69% were on a bowel program. Median age of initiating wheelchair use was 3 years 4 months (range 1y 2mo-12y 5mo). Twenty-four were community ambulators, and they were more likely to have AIS D lesions (half the key muscle functions below the level of injury have a muscle grade 3 or greater) and less likely to have skeletal complications. INTERPRETATIONThe epidemiology, complications, and manifestations of SCIs in children injured at a young age are unique and differ distinctively from adolescent and adult-onset SCIs.Spinal cord injuries (SCIs) are an uncommon occurrence in children aged 5 years and younger but can have a devastating effect on the children and their families. The impact of an SCI in all spheres of life in such young children is immense in view of their relatively long life span and the mutual interaction of SCIs and growth and development. Younger children have relatively unique etiologies for their SCI, such as lap belt or birth injuries, and unique pathophysiology of their injuries, including SCIs without radiographic abnormalities (SCIWORA). Compared with adults and adolescents, younger children who sustain SCIs are more likely to have paraplegia or complete injuries. 1,2 Children who sustain an SCI at a young age are at high risk of a variety of complications such as scoliosis and hip dysplasia.2 In addition, because of their young age at injury and relatively long lifespan, they will most likely be at risk for a variety of aging-related complications throughout their life, including overuse syndromes and cardiovascular disease. 3,4 The purpose of this study is to describe injury-related factors, demographic information, and the incidence of secondary complications that develop in children who sustained an SCI at 5 years of ag...

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.

“…The duration of anticoagulant thromboprophylaxis is generally for at least eight weeks. DVT is very uncommon in children who acquire a SCI between birth and twelve years of age (Vogel, 2011;Schottler, 2012). In contrast, DVT was identified in 8% of those injured between thirteen and fifteen years of age and 9% of those injured between sixteen and twenty-one years of age.…”

Posterior cervical spinal fusion in a 3-week-old infant with a severe subaxial distraction injury

“…3 For this reason, complete spinal cord injuries are common in the pediatric population, with several studies demonstrating a rate between 60% and 69% of pediatric patients with cervical spinal cord injuries. 3,8,16 Identification of cervical injuries in very young children is difficult due to limitations of the neurological examination in this age group. There is inherent difficulty in distinguishing volitional from reflexive movements, in the detection of sensory deficits, and in the assessment of motor function in specific muscle groups.…”

Trunk and respiratory motor control in typically developing children and its implications in children with chronic spinal cord injury.

“…(NSCISC, 2016). SCIs occurrence is children is uncommon, but it can result in devastating psychological and physiological consequences (S. Schottler, Vogel, & Sturm, 2012). The impact of injury at a young age is much greater due to relatively longer life span and interruption of normal development (Schottler et al, 2012).…”

“…Young children who sustain SCI are more likely to have complete injury or paraplegia compared to adults or adolescent who sustain SCI. Children who get injured at an early age are at high risk for secondary complications like, neuromuscular scoliosis and hip dysplasia (Schottler et al, 2012).…”

“…The functional impairments after SCI are variable and depend on the severity of the injury (Powell & Davidson, 2015;Schottler et al, 2012) ISNSCI scale classifies the injury as cervical (C1-8), thoracic (T1-12), lumbar (L1-5) or sacral (S1-5) and myotomes and dermatomes are tested for motor and sensory examination, respectively. ASIA impairment scale is used to grade degrees of impairment.…”