Pediatric Spinal Injuries

Janice S. Hayes; Trish Arriola

Disclosures

Pediatr Nurs. 2005;31(6):464-467. 

In This Article

Signs and Symptoms

Spinal injuries in children present unique challenges. The anatomy of the growing child affects injury patterns and subsequent care. There are many challenges for the child and family, but current research is providing hope for the future.

The incidence of spinal injuries in children is reported to be 2 to 5% of all spine injuries (Reynolds, 2000). Although uncommon, these injuries are more common than anyone would like them to be, and they can be associated with significant morbidity posing challenges to care. Automotive injuries are the most common cause followed by sporting injuries. More than half of pediatric spinal cord injuries occur in the cervical area (Brown, Brunn, & Garcia, 2001; Cirak et al., 2004; Eleraky, Theodore, Adams, Rekate, & Sonntag, 2000).

Spinal cord injuries can be classified as either complete or incomplete. Complete spinal cord injury results in total loss of sensation and movement below the level of the injury. Incomplete spinal cord injuries often fall into one of the following patterns (Schreiber, 2004):

  • Anterior cord syndrome results from injury to the motor and sensory pathways in the anterior cord. These patients can feel some crude sensation, but movement and more detailed sensation is lost.

  • Central cord syndrome is injury to nerve cells and pathways in the center of the cervical spinal cord producing weakness or paralysis of arms and some sensory loss in the arms. The legs are less affected.

  • Brown-Sequard syndrome results from injury to the right or left half of the cord. Movement and some types of sensation are lost below the level of the injury. Pain and temperature sensation are lost on the opposite side of the body because the pathways cross to the opposite side after they enter the spinal cord.

  • Spinal concussion can also occur. This consists of complete or incomplete dysfunction that is transient. It generally resolves within a day or two.

  • Cauda equina syndrome results from injury to the lumbosacral nerve roots caused by central lumbar disk herniation. Loss of reflexes to the affected limbs, bowel, and/or bladder result.

Symptoms of spinal cord injury are not easily discerned in young children and are variable depending on the child's age, the injury location, the spinal fracture stability, and other systemic injuries. Generally, signs of spinal cord injury include the following:

  • Flaccid extremities.

  • Paralysis.

  • Numbness or paresthesias (sensations such as tingling or burning).

  • Paresis or weakness.

  • Priaprism.

  • Incontinence of bowel or bladder and loss of rectal tone.

Other necessary assessments in clude the abdomen (if a lap belt was in place during a motor vehicle crash), rectal tone, and inspection and palpation of the back (Thomas & Bernardo, 2003).

Damage to the vertebrae and ligaments usually causes severe pain and swelling in the area of the injury, and damage to the cord may cause a loss of sensation and/or motor function below the injury. The spinal cord is divided into 31 segments, each with a pair of spinal nerve roots - anterior (motor) and dorsal (sensory). These pairs of anterior and dorsal nerve roots combine to form a spinal nerve as it exits from the vertebral column. The spinal cord is organized into a series of tracts or neuro-pathways that carry motor (descending) and sensory (ascending) information. Spinal shock refers to flaccidity and loss of reflexes that may make the cord appear functionless; the duration is variable, but generally some signs of return to function are seen within the first 72 hours of injury. Neurogenic shock results from impairment of the descending sympathetic pathways resulting in loss of vasomotor tone and sympathetic innervation to the heart. The triad of hypotension, bradycardia, and peripheral vasodilation results (Schreiber, 2004; American College of Surgeons Committee on Trauma, 1997). This is a very important sign in early assessment in the field and the ED.

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