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Pediatric spinal injury: the very young
J R Ruge1, G P Sinson, D G McLone
1Division of Neurosurgery, Northwestern University, Chicago, Illinois.
Insights
Pediatric spinal cord injuries differ from adult injuries, with falls being a common cause. Very young children (≤3 years) show distinct injury patterns compared to older children (4-12 years).
Area of Science:
- Pediatric Traumatology
- Neurology
- Orthopedic Surgery
Background:
- Spinal cord injury (SCI) presentation varies significantly between pediatric and adult populations due to developmental differences in spinal maturity.
- Pediatric SCI constitutes a small but distinct subset of overall SCI cases, necessitating specific clinical considerations.
Purpose of the Study:
- To analyze the clinical characteristics, etiology, and injury patterns of spinal cord injuries in children aged 12 years or younger.
- To identify unique features and differences in pediatric SCI, particularly comparing very young children (≤3 years) to older children (4-12 years).
Main Methods:
- Retrospective review of clinical data from 71 pediatric patients (≤12 years) with spinal cord injuries admitted between June 1972 and June 1986.
- Analysis of injury etiology, neurological status, injury levels, and radiographic findings, including spinal cord injury without radiographic abnormality (SCIWORA).
Main Results:
- Falls were the leading cause (38%) of traumatic SCI in children, differing from adult injury patterns.
- Spinal cord injury without radiographic abnormality (SCIWORA) occurred in 21.3% of cases; complete neurological injury was observed in 19% overall and 40% of SCIWORA cases.
- The C-2 level was the most frequent injury site (27%). Children aged 3 years or younger exhibited significant differences in injury level, surgical stability needs, and sex distribution compared to older children.
Conclusions:
- Pediatric spinal cord injuries, especially in very young children, present unique etiological and epidemiological characteristics.
- Understanding these pediatric-specific injury patterns is crucial for appropriate diagnosis, management, and outcomes in pediatric SCI patients.
Abstract:
Maturity of the spine and spine-supporting structures is an important variable distinguishing spinal cord injuries in children from those in adults. Clinical data are presented from 71 children aged 12 years or younger who constituted 2.7% of 2598 spinal cord-injured patients admitted to the authors' institutions from June, 1972, to June, 1986. The 47 children with traumatic spinal cord injury averaged 6.9 years of age and included 20 girls (43%). The etiology of the pediatric injuries differed from that of adult injuries in that falls were the most common causative factor (38%) followed by automobile-related injuries (20%). Ten children (21.3%) had spinal cord injury without radiographic abnormality (SCIWORA), whereas 27 (57%) had evidence of neurological injury. Complete neurological injury was seen in 19% of all traumatic pediatric spinal cord injuries and in 40% of those with SCIWORA. The most frequent level of spinal injury was C-2 (27%, 15 cases) followed by T-10 (13%, seven cases). Upon statistical examination of the data, a subpopulation of children aged 3 years or younger emerged. These very young children had a significant difference in level of injury, requirement for surgical stability, and sex distribution compared to 4- to 12-year-old children.