Acute Spinal Cord Injury in Children
What is an acute spinal cord injury?
|Click Image to Enlarge|
The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body. It relays data from the brain to the rest of the body and carries sensory information from the body, including the skin, joints, and organs, back to the brain.
Acute spinal cord injury (SCI) is due to a traumatic injury that either results in a bruise (also called a contusion), a partial tear, or a complete tear (called a transection) in the spinal cord. SCI is a common cause of permanent disability and death in children.
What causes an acute spinal cord injury?
There are many causes of SCI in children. The more common injuries occur when the area of the spine or neck is bent or compressed as in the following:
Birth injuries, which typically affect the spinal cord in the neck area
Motor vehicle accidents (automobiles, motorcycles, and being struck as a pedestrian)
Violence (gunshot or stab wounds)
Infections that form an abscess on the spinal cord
What are the symptoms of an acute spinal cord injury?
After a traumatic event, a child may have varying degrees of symptoms associated with the severity and location of the SCI. The location of the injury on the spinal cord will determine how severe the injury will be. For example, an injury that damages the cervical spine (in the neck area) can cause loss of muscle function or strength in the arms and legs as well as loss of sensation below the level of the spinal cord injury. This is referred to as tetraplegia (formerly called quadriplegia) with sensory loss. An injury in the upper spinal cord often results in the need for mechanical breathing assistance with a ventilator due to weak chest muscles. An injury to a lower part of the spinal cord that causes paralysis and loss of function in the legs, as well as sensory loss involving the lower body is called paraplegia.
The extent of the damage to the spinal cord determines whether the injury is complete or incomplete.
A complete injury means that there is no movement or feeling below the level of the injury.
An incomplete injury means that there is still some degree of feeling or movement below the level of the injury.
Initially after a spinal cord injury, the child may have spinal shock. This causes loss or decrease in feeling, muscle movement, and reflexes. As swelling subsides, other symptoms may appear depending on the location of the injury. Generally, the higher up the level of the injury is to the spinal cord, the more severe the symptoms. For example, an injury to the neck, at the first and second vertebrae in the spinal column (C1 or C2), and especially in the mid-cervical vertebrae (C3, C4, and C5), affects the respiratory muscles and the ability to breathe. A lower injury, in the lumbar vertebrae, may affect nerve and muscle control to the bladder, bowel, sexual organs, and legs.
The symptoms of SCI may include:
Loss of voluntary muscle movement in the chest, arms, or legs
Loss of feeling in the chest, arms, legs, or buttocks
Loss of bowel and bladder function
Abnormal autonomic regulation (poor blood pressure control, sweating, shivering, abnormal function of the stomach and intestines)
The symptoms of SCI may look like other medical conditions. Only your child's doctor can diagnosis this condition.
How are acute spinal cord injuries diagnosed?
The full extent of the SCI may not be completely known right away after the injury. But it may be revealed with a comprehensive evaluation and testing. Acute SCI is a medical emergency. Anytime there is a suspicion of injury to the spinal cord, emergent medical attention is necessary. The diagnosis of SCI is made with a physical exam and tests. During the exam, the doctor will ask about the child's medical history and how the injury occurred. Trauma to the spinal cord can cause neurological problems and requires further follow-up. Sometimes, surgery is needed to stabilize the spinal cord after acute SCI.
Tests may include:
X-ray. A test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Computed tomography scan (also called a CT or CAT scan). An imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Magnetic resonance imaging (MRI). A procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
How is an acute spinal cord injury treated?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
SCI requires emergency medical attention on the scene of the accident or injury. This is done by immobilizing the head and neck areas to prevent the child from moving. This may be very difficult since the child, parents, or bystanders may be very frightened after the traumatic incident.
There is no cure to repair a damaged or bruised spinal cord. The severity of the SCI and the location determines if the SCI is mild, severe, or fatal.
Surgery is sometimes needed to evaluate the injured cord, stabilize fractured backbones, decompress (or release) the pressure from the injured area, and to manage any other injuries from an accident. Treatment is individualized depending on the extent of the condition and the presence of other injuries in the child.
Treatment may include:
Observation and medical management in the intensive care unit
Medicines, such as corticosteroids (which may help decrease the swelling in the spinal cord)
Mechanical ventilator. A breathing machine used to help the child breathe.
Bladder catheter. A tube that is placed into the bladder that helps to drain the urine into a collection bag.
Feeding tube. This is placed through the nostril to the stomach or directly through the abdomen into the stomach to provide extra nutrition and calories for the child.
Recovery from a SCI requires long-term hospitalization and rehabilitation. A team of doctors, nurses, therapists (physical, occupations, or speech), and other specialists work to manage your child for pain control, monitor the heart function, blood pressure, body temperature, nutritional status, bladder and bowel function, and attempt to control involuntary muscle shaking (spasticity). Rehab focuses on preventing muscle wasting, and contractures, and works to retrain your child to use other muscles, to aid in mobility and movement. Some of the important chronic complications of SCI include pressure ulcers, also called bedsores, and pneumonia.
Lifelong considerations for a child with a SCI
A traumatic event that results in a SCI is devastating to the child and the family. Your child's healthcare team will educate the family after hospitalization and rehabilitation on how to best care for your child at home. They will also outlines specific problems that require immediate medical attention.
The disabled child requires a focus on maximizing his or her capabilities at home and in the community. Positive reinforcement will encourage your child to strengthen his or her self-esteem and promote independence.
A child with a SCI requires frequent medical checks and testing after hospitalization and rehabilitation to monitor his or her progress.