European Spine Journal

, Volume 5, Issue 3, pp 148–152

Spinal injuries in the pediatric age group: a review of 82 cases of spinal cord and vertebral column injuries

  • M. Turgut
  • G. Akpinar
  • N. Akalan
  • O. E. Özcan
Original Article

Abstract

A review of 82 children with spinal cord and/or vertebral column injury treated in our department between 1968 and 1993 showed that 67% of the patients were boys and the average age was 11.4 years. The cause, vertebral level, and type of injury, and the severity of neurological injury varied with the age of the patient. The cause of pediatric injuries differed from that of adult injuries in that falls were the most common causative factor (56%) followed by vehicular accidents (23%). The most frequent level of spinal injury was in the cervical region (57%, 47 patients) followed by the lumbar region (16.5%, 13 patients). In our series, 18% of the patients had complete injury and the overall mortality rate was 3.6%. Eleven children (13%) had spinal cord injury without radiographic abnormality (SCIWORA), whereas 39 (47%) had evidence of neurological injury. Although the spinal injury patterns differed between children and adolescents, the outcome was found to be predominantly affected by the type of neurological injury (P<0.05). Children with complete myelopathy uniformly remained with severe neurological dysfunction; children with incomplete myelopathy recovered nearly normal neurological function. Finally, the authors conclude that most spinal injuries can be successfuly managed with nonoperative therapy. The literature is reviewed as to the treatment and outcome of pediatric spinal injuries.

Key words

Pediatric spine Spinal cord injury Spine 

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References

  1. 1.
    Anderson JM, Schutt AH (1980) Spinal injury in children: a review of 156 cases seen from 1950 through 1978. Mayo Clin Proc 55:499–504Google Scholar
  2. 2.
    Babcock JL (1975) Spinal injuries in children. Pediatr Clin North Am 22:487–500Google Scholar
  3. 3.
    Beatson TR (1963) Fractures and dislocations of the cervical spine. J Bone Joint Surg [Br] 45:21–35Google Scholar
  4. 4.
    Benzel EC, Hart BL, Ball PA et al (1994) Fractures of the C2 vertebral body. J Neurosurg 81:206–212Google Scholar
  5. 5.
    Betz RR, Gelman AJ, DeFilipp GJ et al (1987) Magnetic resonance imaging in the evaluation of spinal cord injured children and adolescents. Paraplegia 25:92–99Google Scholar
  6. 6.
    Boltze W-H (1994) Treatment strategies in traumatic cervical spinal cord injuries with tetraplegia. Neurosurg Rev 17:127–130Google Scholar
  7. 7.
    Bracken MB, Shepard MJ, Collins WF (1990) A randomized trial of methyl-prednisolone or naloxone in the treatment of acute spinal cord injury. N Engl J Med 322:1405–1411Google Scholar
  8. 8.
    Campbell J, Bonnet C (1975) Spinal cord injury in children. Clin Orthop 112:114–123Google Scholar
  9. 9.
    Catz A, Appel I, Reider-Grosswasser I et al (1993) Late-onset papilledema following spinal injury. Case report. Paraplegia 31:131–135Google Scholar
  10. 10.
    Frankel HL, Hacock DO, Hyslop G et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7:179–192Google Scholar
  11. 11.
    Frenguelli A, Ruscito P, Bicciolo G et al (1991) Head and neck trauma in sporting activities. Review of 208 cases. J Cranio-Max-Fac Surg 19:178–181Google Scholar
  12. 12.
    Grabb PA, Pang D (1994) Magnetic resonance imaging in the evaluation of spinal cord injury without radiographic abnormality in children. Neurosurgery 35:406–414Google Scholar
  13. 13.
    Hachen HJ (1977) Spinal cord injury in children and adolescents: diagnostic pitfalls and therapeutic considerations in the acute stage. Paraplegia 15:55–64Google Scholar
  14. 14.
    Hadley MN, Zambramski MJ, Browner MC et al (1988) Spinal trauma. J Neurosurg 68:18–24Google Scholar
  15. 15.
    Haffner DL, Hoffer MM, Wiedbusch R (1993) Etiology of children's spinal injuries at Rancho Los Amigos. Spine 18:679–684Google Scholar
  16. 16.
    Hasue M, Hoshino R, Omata S (1974) Cervical spine injuries in children. Fukushima J Med Sci 20:115–123Google Scholar
  17. 17.
    Hill SA, Miller CA, Kosnik EC et al (1984) Pediatric neck injuries. A clinical study. J Neurosurg 60:700–706Google Scholar
  18. 18.
    Hirsh LF, Duarte L, Wolfson EH (1993) Thoracic spinal cord injury without spine fracture in an adult: case report and literature review. Surg Neurol 40:35–38Google Scholar
  19. 19.
    Hubbard DD (1974) Injuries of the spine of children and adolescents. Clin Orthop 100:56–65Google Scholar
  20. 20.
    Kiwerski JE (1993) Neurological out-come from conservative or surgical treatment of cervical spinal cord injured patients. Paraplegia 31:192–196Google Scholar
  21. 21.
    Lynn MG, Goodman SJ (1975) Cervical spine injuries in infants. J Neurosurg 42:179–184Google Scholar
  22. 22.
    Mandabach M, Ruge JR, Hahn YS et al (1993) Pediatric axis fractures: early halo immobilisation, management and outcome. Pediatr Neurosurg 19:225–232Google Scholar
  23. 23.
    Maves CK, Souza A, Prenger EC et al (1991) Traumatic atlanto-occipital disruption in children. Pediatr Radiol 21:504–507Google Scholar
  24. 24.
    Melzak J (1969) paraplegia among children. Lancet II:45–48Google Scholar
  25. 25.
    Osenbach RK, Menezes AH (1989) Spinal cord injury without radiographic abnormality in children. Pediatr Neurosci 15:168–175Google Scholar
  26. 26.
    Pang D, Pollack IF (1989) Spinal cord injury without radiographic abnormality in children: the SCIWORA syndrome. J Trauma 29:654–664Google Scholar
  27. 27.
    Pang D, Wilberger EJ (1982) Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57:114–129Google Scholar
  28. 28.
    Ruge JR, Sinson GP, Mclone DG et al (1988) Pediatric spinal injury. J Neurosurg 68:25–30Google Scholar
  29. 29.
    Sherk HH, Schot L, Lane JM (1976) Fractures and dislocations of the cervical spine in children. Orthop Clin North Am 7:593–604Google Scholar
  30. 30.
    Silberstein M, Hennessy O (1993) Implications of focal spinal cord lesions following trauma: evaluation with magnetic resonance imaging. Paraplegia 31:160–167Google Scholar
  31. 31.
    Walsh JW, Stewens DE, Young AB (1983) Traumatic paraplegia in children without contiguous spinal fracture or dislocation. Neurosurgery 12:439–445Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • M. Turgut
    • 1
  • G. Akpinar
    • 3
  • N. Akalan
    • 3
  • O. E. Özcan
    • 3
  1. 1.Department of NeurosurgeryAdnan Menderes University Medical SchoolAydinTurkey
  2. 2.Mesrutiyet Mahallesi, Gençlik CaddesiAydinTurkey
  3. 3.Department of NeurosurgeryHacettepe University Medical SchoolAnkaraTurkey

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