Spinal Injuries in Children

Pediatric spine injures are not that common. Most injuries happen in a motor vehicle accident, while others happen as a result of diving in shallow water. Injuries can happen to the cervical, thoracic, lumbar and sacral spine. They can be stable injuries that require little intervention and that do not affect the spinal cord or they can be unstable injuries at risk for spinal cord damage at any point in time. These often require operative intervention in order to stop the chances that the fracture pieces will pierce the spinal cord and to stop the spine from subluxing spontaneously and pinching off or lacerating the cord.

In the study, the researchers looked at the medical records of 89 patients with a mean age of 13.2 years of age. A total of 46 patients were boys and 43 patients were girls. The age range was 3 years to 16 years of age. Only those with thoracic, lumbar or sacral injuries were evaluated. The most common cause of injury was car accidents. Eighty two patients or 92 percent wee between the ages of 10 to 16 years. Seven patients or 8 percent were between the ages of 3 and 9 years of age.

These patients had a wide range of injuries to the spine including a fracture in 91 percent, a fracture and dislocation in 7 percent, a dislocation in 1 percent and a ligamentous injury in another 1 percent. The most common site of injury was at the level of the lumbar spine in the region of L2 to L5 in 30 percent of cases. The sacrum was least injured at 5 percent of total injuries.
Fortunately, 85 percent of cases were neurologically intact at the time of their injury. This means that no spinal cord trauma existed in the cases. Five percent of cases had incomplete spinal cord injuries and another 10 percent had completely damaged spinal cords with serious injuries and paralysis.

Patients underwent surgery to their spinal injuries 26 percent of the time. A total of 76 percent of injuries had nonsurgical management. In those who had surgery, only 7 percent had a anterior approach to their surgical repair while the rest had a posterior approach or a combined anterior and posterior approach (1 case).

Fortunately, six patients who had neurological deficits had improvement in their symptoms. One patient actually recovered completely from what doctors believed was a completed injury. There may have been swelling of the spinal cord that resolved itself, leading to a complete recovery.

In conclusion, the researchers noted that thoracic and lumbar spinal injuries were more common in older children and that multilevel damage was not uncommon. This means that even if one spinal injury is found, doctors should take a look at other areas of the spine for other injuries. Most patients were treated without surgery with a prognosis that depends on the early findings. Even though one patient recovered completely from a complete injury, this was not common and most patients were left with the injuries they had at the time of the injury.

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