{
 "topic": "Spinal Cord Injury",
 "slug": "spinal-cord-injury",
 "category_id": 15606,
 "passage_count": 14,
 "source_chars": 11903,
 "enough_material": true,
 "references": [
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    626,
    4431,
    4432
   ]
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    2639,
    8409,
    8412,
    8413
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  },
  {
   "title": "Algorithms in Pediatrics",
   "author": null,
   "pages": [
    240
   ]
  },
  {
   "title": "MedStudy Pediatrics Core 11th Edition 2024-2025",
   "author": null,
   "pages": [
    1063
   ]
  },
  {
   "title": "Diagnostic Imaging: Pediatrics",
   "author": "A. Carlson Merrow Jr. MD",
   "pages": [
    1130,
    1161
   ]
  },
  {
   "title": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition",
   "author": "Tricia Lacy Gomella, Fabien G. Eyal and Fayez Bany-Mohammed",
   "pages": [
    809
   ]
  }
 ],
 "passages": [
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 626",
   "text": "## **Spinal Cord Injuries in Children** ## _Katie P. Fehnel and Mark R. Proctor_ See also Chapter 751. Compared with adults, spine and spinal cord injuries are rare in children, particularly young children, because of both anatomic differences and etiologies of injury. The main mechanisms of injury to the spine are motor vehicle crashes, falls, sports, and violence, which affect young children less often (see Chapter 80)."
  },
  {
   "source": "Cover, p. 8409",
   "text": "## **SPINAL CORD INJURY** ## **ETIOLOGY AND PATHOPHYSIOLOGY** As with TBI, the mechanisms of injury in pediatric SCI vary by age group. We most often think of traumatic SCI, which occurs in association with motor vehicle accidents (MVA), assaults/stabbings/gunshot wounds (violence), sports, and falls; however, in pediatric SCI, the nontraumatic causes are more prevalent than in adults and include hematologic and oncologic etiologies. Nontraumatic SCIs require following similar principles laid out in the rest of this chapter, although they have their own complexities of care. Either way, the primary pathophysiology of the injury stems from physical damage, whereas secondary injury is associated with cord neurometabolic pathways of distress including edema, hypoxia, and ischemia. Whereas a deeper explanation is beyond the scope of this chapter, 2 sentinel concepts need to be addressed: spinal shock and SCI without radiograph abnormality (SCIWORA)."
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 626",
   "text": "Although the mechanisms of spinal cord injury in children include birth trauma, falls, and child abuse, the major cause of morbidity and mortality across all ages remains **motor vehicle injuries** . Adolescents incur spinal cord injuries with epidemiology similar to that of adults, including significant male predominance and a high likelihood of fracture dislocations of the lower cervical spine or thoracolumbar region. In infants and children <5 years old, fractures and mechanical disruption of spinal elements are more likely to occur in the upper cervical spine between the occiput and C3. Certain conditions predispose to C- spine injury (Table 81.1). ## **CLINICAL MANIFESTATIONS**"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Acute spinal cord compression in children is usually caused by trauma, infection, or cancer. Spinal trauma may lead to contusion or concussion of the cord with hemorrhage, edema, and local mass effect, or may lead to development of a spinal epidural hematoma. Mass lesions may cause damage by direct compression of spinal cord tissues or, secondarily, by interference with the tenuous arterial (or, less commonly, venous) blood flow to the spinal cord, with resultant spinal cord infarction. Parenchymal injury usually presents acutely, but an epidural hematoma may develop over several days after the antecedent trauma. Epidural abscess is the most common infectious cause of spinal cord compression. It is usually caused by hematogenous spread of bacteria, with Staphylococcus aureus being the most common pathogen. Neoplastic causes include both primary intraspinal tumors (ependymoma and astrocytoma) and extrinsic lesions such as neuroblastoma or lymphoma."
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 4431",
   "text": "## See Chapter 81. Individuals from birth to 21 years of age account for 25% of all cases of traumatic **spinal cord injury (SCI)** . Children are more susceptible to lap- belt injuries, upper cervical injuries, SCIs without radiologic abnormalities **(SCIWORA)** , and delayed onset of neurologic deficits, ranging from 30 minutes to 4 days. A population- based study found the epidemiology of pediatric spinal injury in the US varies greatly by age, ethnicity, and payor. Low- income populations are more likely to sustain spinal cord injury due to firearms than other populations. The most accurate way to evaluate a patient who has sustained an SCI is by performing a standardized physical examination, as endorsed by the International Standards for Neurological and Functional Classification of SCI, recommended for children 6 years of age and older (Fig. 751.1). Life expectancy is related to the neurologic level of injury and the American Spinal Injury Association (ASIA) impairment scale classification."
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 4432",
   "text": "## See Chapter 81. Individuals from birth to 21 years of age account for 25% of all cases of traumatic **spinal cord injury (SCI)** . Children are more susceptible to lap- belt injuries, upper cervical injuries, SCIs without radiologic abnormalities **(SCIWORA)** , and delayed onset of neurologic deficits, ranging from 30 minutes to 4 days. A population- based study found the epidemiology of pediatric spinal injury in the US varies greatly by age, ethnicity, and payor. Low- income populations are more likely to sustain spinal cord injury due to firearms than other populations. The most accurate way to evaluate a patient who has sustained an SCI is by performing a standardized physical examination, as endorsed by the International Standards for Neurological and Functional Classification of SCI, recommended for children 6 years of age and older (Fig. 751.1). Life expectancy is related to the neurologic level of injury and the American Spinal Injury Association (ASIA) impairment scale classification."
  },
  {
   "source": "Algorithms in Pediatrics, p. 240",
   "text": "- Pupil size and reactivity - Extremity movement and tone - Posturing - Reflexes. Management: Address findings in keeping with increased intracranial pressure and/or spinal cord injury without radiological abnormality. - Continuous reassessment; tracking of vitals and urine output. ## **Head Trauma** - Leading cause of death - Results in significant morbidity - Hypotension and hypoxia from concurrent injury adversely affect the outcome from intracerebral injury. ## **Spinal Cord Injury without Radiological Abnormality** - If spinal cord injury is suspected on the basis of mechanism or clinical examination, do not be dissuaded by normal X-rays - A normal X-ray and initial exam is not enough - Be aware of: local pain, torticollis. - Management: - Avoid secondary and iatrogenic injury - Corticosteroids are currently not recommended. ## **Chest and Abdomen** ## **Exposure with Environmental Control** - Logroll to examine back - Look under hair, collar, and splints."
  },
  {
   "source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 1063",
   "text": "compromised. Most children with spinal cord tumors/masses present with back pain. Other less common symptoms include a combination of gait disturbance, weakness, scoliosis, and sphincter dysfunction. In younger children, motor regres- sion can also be a presenting symptom. Symptoms will vary depending on the location (Table 25-4). Spinal Cord Lesion Level Clinical Manifestations Above T10 * Symmetric weakness * Increased lower extremity deep tendon reflexes * Sensory level deficit * Up-going toes Conus medullaris (T10 to L2)__\u00ab Symmetric weakness * Increased knee reflexes * Decreased ankle reflexes * Saddle sensory loss \u2018* Up-going or down-going toes \u2018* Asymmetric weakness \u2018* Loss of lower extremity deep tendon reflexes * Sensory deficit \u2018* Down-going toes Cauda equina (below L2) 25-11"
  },
  {
   "source": "Diagnostic Imaging: Pediatrics, p. 1161",
   "text": "- \u25cb10-20% incidence ## **Congenital Fusion & Segmentation Anomalies** - C1-occiput, C1-C2 ## **Natural History & Prognosis** - Neurological status at presentation best predictor of outcome - \u25cbIntact or incomplete injury \u2192 likely good outcome - \u25cbComplete loss of function at level of injury \u2192 poor chance of recovery - Spinal cord hemorrhage \u2192 worse potential for recovery ## **Treatment** - Support of impaired systemic function - Stabilization of spine to prevent further injury - Internal or external surgical stabilization - \u25cbMay impair ability to assess with MR - Emergent decompression of spinal cord impingement - Administration of steroids for acute spinal cord injury no longer recommended ## **SELECTED REFERENCES** 1. Henry M et al: A retrospective comparison of CT and MRI in detecting pediatric cervical spine injury. Childs Nerv Syst. 29(8):1333-8, 2013 2. Booth TN: Cervical spine evaluation in pediatric trauma. AJR Am J Roentgenol. 198(5):W417-25, 2012"
  },
  {
   "source": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition, p. 809",
   "text": "- **I. Spinal cord injuries.** Rare (<0.2 per 10000 births) and are caused by lateral or longitudinal stretching force of the neck or hyperextension or torsion of the fetal neck. Signs vary depending on the location of the injury, and these injuries usually occur with breech deliveries or use of forceps. They can involve meningeal damage with epidural hemorrhage, spinal artery occlusion, vertebral artery injuries and occlusion, laceration of the spinal nerve roots and bruising, and laceration or complete transection of the cord. The higher the injury, the greater is the risk of respiratory problems. Suspect this in a neonate with severe respiratory compromise and profound hypotonia. Spinal shock can occur, which presents with paralyzed abdominal movements, diaphragmatic breathing, distended bladder, and extremities that are flaccid."
  },
  {
   "source": "Diagnostic Imaging: Pediatrics, p. 1130",
   "text": "**1103** This page intentionally left blank ## **SECTION 8** Spine ||Approach to Pediatric Spine|**1106**|| |---|---|---|---| ||**Congenital Spinal Malformations**||| ||Myelomeningocele|**1108**|| ||Lipomyelomeningocele|**1110**|| ||Dorsal Dermal Sinus|**1111**|| ||Caudal Regression|**1112**|| ||Split Cord Malformation|**1113**|| ||Terminal Myelocystocele|**1114**|| ||Neurenteric Cyst|**1115**|| ||Tethered Spinal Cord|**1116**|| ||Scoliosis|**1117**|| ||Syringomyelia|**1118**|| ||**Neoplasms**||| ||Spinal Cord Ependymoma|**1120**|| ||Spinal Cord Astrocytoma|**1122**|| ||Sacrococcygeal Teratoma|**1124**|| ||**Infammatory Lesions**||| ||Discitis/Osteomyelitis|**1128**|| ||Guillain-Barr\u00e9 Syndrome|**1130**|| ||Transverse Myelitis|**1132**|| ||**Trauma**||| ||Craniocervical Junction Injuries|**1134**|| ||Chance Fracture|**1138**|| ||Spondylolysis and Spondylolisthesis<br>DI3_Pediatric_Sectionals_Sept.07.2016.indd 14|**1140**<br>9/8/16 11:36 AM|| Approach to Pediatric Spine"
  },
  {
   "source": "Cover, p. 8412",
   "text": "Although the deficits seen in pediatric SCI range from full tetraplegia requiring respiratory ventilation to slight distal dysesthesias and weakness, primary determinants of function include the SLOI, NLOI, and completeness/incompleteness of injury. Injuries to the spinal cord require interdisciplinary team management (eg, neurosurgery, critical care, trauma surgery, neurology, physical medicine and rehabilitation, physical therapy, occupational therapy, speech therapy, social work, psychology, neuropsychology). Most patients will require acute inpatient rehabilitation for the development of age-appropriate, individualized programs for range of motion, strengthening, and early mobilization, as well as individualized education of the child and family on gastric/duodenal stress ulcer prevention, pressure ulcer prevention (regular skin checks, rotation schedule), thermoregulation (impaired heat and cold regulation with adjustment to ambient temperatures), anticoagulation recommendations for prolonged"
  },
  {
   "source": "Cover, p. 8413",
   "text": "- Selvarajah S, Schneider EB, Becker D, Sadowsky CL, Haider AH, Hammond ER. The epidemiology of childhood and adolescent traumatic spinal cord injury in the United States: 2007\u20132010. _J Neurotrauma_ . 2014;31(18):15481560. - Slomine BS, McCarthy ML, Ding R, et al. Health care utilization and needs after pediatric traumatic brain injury. _Pediatrics_ . 2006;117(4):e663-e674. - Witiw CD, Fehlings MG. Acute spinal cord injury. _J Spinal Disord Tech_ . 2015;28:202-210. ## **545 Stroke in Neonates and Children** ## Lisa Nassif Wright ## **INTRODUCTION**"
  },
  {
   "source": "Cover, p. 2639",
   "text": "## **SPINAL CORD INJURIES** Spinal cord injuries are part of the differential diagnosis of hypotonia only during the newborn period. Almost all cervical spine injuries occur during vaginal delivery, specifically with breech presentation. The extent of injury can vary from mild edema to complete disconnection of the spinal cord. Depending on the severity and the level of the pathology, the patients may present with hypotonia/weakness, loss of sensory modalities, absent reflexes, bowel and bladder dysfunction, and/or abnormal breathing. Screening of the spinal cord with an MRI is important if there is a concern for spinal cord injury. Treatment is supportive in these patients. ## **SPINAL CORD ANOMALIES**"
  }
 ]
}