High rates of neurological improvement following severe traumatic pediatric spinal cord injury.
METHODS
Retrospective single-center study


OBJECTIVE
To determine the long-term outcome of pediatric spinal cord injuries


BACKGROUND
Spinal cord injuries are uncommon events in the pediatric population. In the few large series reported in the literature, recovery of neurologic function was demonstrated after mild injuries but was rare after severe injuries.


METHODS
A total of 4,876 cases of pediatric trauma treated at the Children's Hospital of Los Angeles over a 9-year period (1993-2001) were reviewed. During the study period, 91 cases of spinal cord or spinal column injury were identified, and 30 cases involving a spinal cord injury were identified. Cauda equina injuries were excluded. Seven craniocervical, 12 cervical, 5 thoracic, and 6 thoracolumbar cases were identified. There were 6 cases of spinal cord injury without radiographic abnormality. Eight of the 30 patients received methylprednisolone at the time of admission. Follow-up ranged from 2 to 54 (mean = 19) months.


RESULTS
Twenty patients presented with complete injuries (ASIA grade A). Of these, 7 died, 7 had no neurologic recovery, and 6 experienced neurologic improvement. Five of these six eventually became ambulatory with functional gains occurring over a 4- to 50-week period. None of these 5 patients was found to have spinal cord injury without radiographic abnormality. Of the remaining 10 patients (grades B-D), 8 experienced improvements in neurologic function. Cervical dislocation injuries were associated with a low likelihood of neurologic improvement and atlanto-occipital injuries were associated with early death.


CONCLUSIONS
Recovery of neurologic function following severe traumatic spinal cord injury occurs with a significantly greater incidence in children than adults, and these improvements can occur over a prolonged postinjury period.
Wang
Michael Y
MY
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, USA.
Hoh
Daniel J
DJ
Leary
Scott P
SP
Griffith
Pamela
P
McComb
J Gordon
JG
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D001269:Atlanto-Occipital Joint / Q000293:injuries; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D004204:Joint Dislocations / Q000401:mortality; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology; D010264:Paraplegia / Q000453:epidemiology / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D016103:Spinal Fractures / Q000150:complications / Q000453:epidemiology; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome