SPINAL CORD INJURIES

Acute spinal cord injuries in children range from mild concussion to contusions, laceration and complete transaction and may occur even without vertebral fractures. Spinal cord injury without radiographic vertebral abnormality (SCIWORA) is more common in children than adults.

Common causes of spinal cord injury in children include breech delivery, vehicular/sports accidents, physical abuse (Shaken baby syndrome) or vertebral pathologies as seen in Down syndrome (atlanto-axial joint instability), hemolytic anemia (extramedullary erythropoiesis), Pott's spine and tetanus (during spasms).

Clinical manifestations depend on the site and extent of injury. Complete transaction presents with a stage of spinal shock with acute flaccid paralysis and definite level of sensory loss below the lesion during first 24-48 hours.

This stage of spinal shock may persist from few hours to few weeks, followed by gradual development of spasticity and other upper motor neuron signs. Bladder/ bowel dysfunction is common. High cervical (C₁-₂) injury may cause sudden death due to respiratory arrest.

Diagnosis rests on spinal MRI. Periodic cervical X-rays are advised in high-risk cases, e.g. Down syndrome, to detect atlantoaxial instability (gt;4.5 mm distance between odontoid process of axis and anterior arch of atlas).

Management of spinal cord injury includes: (a) stabi­lization and immobilization of spine during resuscitation and transport, (b) high-dose IV methylprednisolone (30 mg/kg Loading followed by 5.4 mg/kg/hr), (c) diagnostic confirmation by MRI, and (d) definitive orthopedic interventions, as required

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