Permanent flaccid paraplegia in children with thoracic spinal cord injury.
From January 1960 to March 1979 25 children with spinal cord injury were admitted to our hospital (10 newborns with birth injury to the spinal cord were excluded). Among 12 patients with complete thoracic lesions four remained permanently flaccid. These four cases who had sustained relatively minor trauma showed marked muscular atrophy of the lower limbs, areflexia, absence of anal and cremasteric reflexes, no response to plantar stimulation and no foot deformities. In contrast to children with spastic traumatic paraplegia, motor nerve conduction velocities and H-reflexes were not measurable in these flaccid patients. Myelography was performed in two, this showing myelomalacia below the level of injury. All four patients had clinically an autonomous bladder and voided by gentle manual pressure. The clinical, neurophysiological and radiological findings are consistent with a lower motor neurone lesion below the level of cord injury, resulting presumably from an extensive longitudinal cord lesion on a vascular basis. Judging from Guttmann's experience, flaccid paraplegia occurs in about 12 per cent of adults with complete thoracic cord lesions. The literature is too scant to give an estimate of this complication in children with traumatic paraplegia.
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009192:Myelography; D009431:Neural Conduction; D010264:Paraplegia / Q000209:etiology* / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D013898:Thoracic Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology