Spinal cord injuries in children are a critical medical condition that requires immediate attention and specialised care. While less common in children than adults, these injuries can significantly impact a child’s development, mobility, and overall quality of life.

This comprehensive blog will explore paediatric spinal cord injuries, their causes, symptoms, diagnosis, treatment options, and the crucial role of caregivers in the recovery process.

What Is a Spinal Cord Injury?

The spinal cord is a vital part of the central nervous system, running from the brainstem down the back. It carries messages between the brain and the rest of the body. Damage to the spinal cord, whether due to trauma or abnormalities, can result in partial or complete loss of motor, sensory, or autonomic function below the level of the injury.

The developing nature of the skeletal and muscular systems of children can make them more vulnerable to certain types of spinal injuries compared to adults.

Symptoms of Paediatric Spinal Cord Injuries

Understanding child spinal injury symptoms is crucial for timely diagnosis and treatment. Symptoms vary based on the severity and location of the injury.

Diagnosis of Spinal Cord Injuries in Children

The diagnosis of spinal cord injuries in children typically involves a combination of clinical assessment, imaging studies, and other diagnostic tests. Here’s an overview of the process:

Initial Clinical Assessment

The doctor will gather information about the injury, including how it occurred, the child’s symptoms, and any prior medical conditions. This may involve speaking with the child (if they are old enough) and caregivers. The physician will assess the child for signs of spinal cord injury including:

• Motor function: Testing strength and movement in the arms and legs.
• Sensory function: Assessing sensation to light touch, pinprick, and temperature.
• Reflexes: Checking for abnormal reflexes such as hyperreflexia or the absence of reflexes.
• Pain and tenderness: Evaluating the spine for areas of tenderness or deformity.

Imaging Studies

• X-rays: Initial imaging with X-rays is often done to detect fractures or dislocations of the vertebrae that could be contributing to the spinal cord injury. X-rays may be limited in detecting soft tissue or spinal cord damage.
• Magnetic Resonance Imaging (MRI): MRI is the most effective imaging technique to assess the spinal cord and soft tissues. It helps visualise the extent of damage, spinal cord compression, swelling, or any herniated discs that may be causing the spinal cord injury.
• Computed Tomography (CT) Scan: A CT scan may be used for detailed views of bone structures in cases where X-rays are insufficient. It can also detect fractures and help with surgical planning.

Electromyography (EMG) and Nerve Conduction Studies

• EMG: This test can assess the electrical activity in muscles and nerves, helping to determine the severity of nerve damage.
• Nerve Conduction Studies: These tests measure how well electrical impulses move through the nerves and can provide insight into the function of the spinal cord and nerves.

Additional Tests

• Urodynamic Studies: If the child has bladder or bowel dysfunction, these tests can assess how well the bladder and bowel are functioning and whether SCI is affecting them.
• Blood Tests: Blood tests may be ordered to look for signs of infection, inflammation, or other underlying conditions that could be contributing to symptoms.

Consultation with Specialists

A specialist may be consulted to assess the need for surgery and the potential for long-term recovery. If the injury is confirmed, a rehabilitation plan may involve physiatrists, physical therapists, occupational therapists, and speech therapists to help with recovery and maximise function.

Treatment Options for Paediatric Spinal Cord Injuries

Treatment for paediatric spinal cord injuries aims to minimise damage, manage symptoms, and promote recovery through a customized, multi-disciplinary approach.

Rehabilitation

An important aspect of the treatment of paediatric spinal cord injuries is rehabilitation. Some of the commonly used rehabilitation techniques include:

• Physical Therapy: Physical therapists work with the child to improve movement, strength, and mobility. This includes exercises to strengthen muscles, maintain joint flexibility, and prevent contractures.
• Occupational Therapy: Occupational therapists help the child adapt to daily tasks, like feeding, dressing, and personal hygiene, and may provide assistive devices for independence.
• Speech Therapy: If the injury affects speech or swallowing, speech therapy can assist with improving communication and safe eating habits.
• Psychological Support: Spinal cord injuries can have emotional and psychological impacts on the child and family. Psychological counselling, support groups, and therapy are critical for coping with the challenges of the injury and its long-term effects.

Emergency Care

The main goal in treating a spinal cord injury is to prevent further damage by immobilising the spine and ensuring the child’s breathing and hydration are stable. Support such as intubation or mechanical ventilation may be needed, along with IV fluids and medications.

Medications

• Steroids: High-dose steroids (such as methylprednisolone) may be administered within hours of the injury to reduce inflammation and swelling around the spinal cord. However, the use of steroids is controversial, and their potential benefits should be weighed against possible side effects.
• Pain Management: Analgesics, such as opioids or non-steroidal anti-inflammatory drugs (NSAIDs), may be used to control pain and discomfort.
• Antibiotics: If there’s a risk of infection (e.g., open fractures or surgical procedures), antibiotics may be prescribed.

Surgical Intervention

Spinal surgery is sometimes needed to relieve pressure on the spinal cord and nerves caused by fractures, dislocated bones, or herniated discs. It can also be done to stabilise the spine with screws, rods, or plates, and to join vertebrae together with spinal fusion to prevent further movement or instability.

Management of Secondary Complications

Children with spinal cord injuries face challenges in managing their bladder and bowel functions, as well as potential respiratory issues. Preventative measures for pressure sores are crucial due to limited mobility. Spasticity, characterised by muscle tightness, may require medication, therapy, or surgery. Prompt and comprehensive treatment is vital for the best outcomes for these children.

Long-term Follow-up and Support

Children with spinal cord injuries undergo rehabilitation following the acute phase to improve recovery and adjust to life with the condition. Mobility aids such as wheelchairs or braces may be necessary depending on the level of injury to enhance independence. Ongoing support from educators, social workers, and community resources aids in the child’s adjustment to school and social environments.

Experimental and Emerging Treatments

Depending upon the condition, the doctor may try experimental treatments such as:

• Stem Cell Therapy: Research into stem cell therapy for spinal cord injury is ongoing, and clinical trials are exploring whether stem cells can regenerate damaged spinal cord tissue.
• Neurostimulation and Electrical Stimulation: Techniques like epidural spinal cord stimulation may help restore some function in children with certain types of spinal cord injuries.
• Gene Therapy: Experimental treatments are exploring the possibility of using gene therapy to repair or regenerate damaged spinal cord neurons.

Family and Emotional Support

Families play a critical role in the recovery process. Support groups, therapy, and family counselling can help address the emotional impact of spinal cord injuries. With proper accommodations, many children can continue their education and participate in social activities. Schools and communities need to be supportive and inclusive.

Prognosis

The outcome of paediatric spinal cord injury depends on the level and severity of the injury. Children with injuries at higher levels of the spinal cord (such as cervical spine) may face more severe functional impairments, while those with lower injuries (such as lumbar or sacral spine) may have better chances of recovery. Early intervention, effective rehabilitation, and ongoing support are critical factors that contribute to long-term outcomes.

Preventing Paediatric Spinal Cord Injuries

Preventing paediatric spinal cord injuries involves using safety measures, increasing awareness, and modifying the environment. To reduce the risk of injury in curious and active children, it is important to implement preventive measures, especially during high-risk activities.

Vehicle Safety

Ensure children use the correct car seat based on age, weight, and height. Seatbelt safety is important for all ages, with lap belts across the thighs and shoulder belts across the chest. Avoid distracted driving and speeding, as vehicle accidents are a leading cause of spinal cord injuries in children.

Sports Safety

Children should wear helmets and protective gear for sports, receive proper training and supervision to prevent risky behaviours and play on safe surfaces to minimise the risk of injuries.

Fall Prevention

Use safety gates, window guards, and secure furniture to prevent accidents. Keep floors clear and supervise children during play to prevent falls. Ensure playground equipment is safe and have soft landing surfaces nearby.

Prevention of Physical Abuse

Parents, caregivers, and educators should be aware of the signs of physical abuse, such as unexplained bruises or fractures, which could lead to SCI. Early intervention can prevent harm. Training for caregivers and child service professionals can help recognise and prevent abusive behaviours that could result in spinal injuries, such as shaking or hitting.

Preventing Medical Conditions Leading to SCI

Vaccines, such as those for polio, can prevent infections that might affect the spinal cord. Proper care of any underlying medical conditions (such as spina bifida or scoliosis) can reduce the risk of spinal cord injuries.

Sources:

• https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes
• https://www.childrens.com/specialties-services/conditions/spinal-cord-injury
• https://www.spinalcord.com/spinal-cord-injury-prevention
• https://www.chop.edu/conditions-diseases/acute-spinal-cord-injury-children
• https://www.flintrehab.com/spinal-cord-injury-treatment/
• https://www.physio-pedia.com/Paediatric_Spinal_Cord_Injury
• https://www.icliniq.com/articles/orthopedic-health/paediatric-spinal-cord-injury