Pediatric spinal cord injury

What is a pediatric spinal cord injury?

When the nerves stop working, your child’s body can be affected in ways you can see, such as an inability to move his legs. Doctors will diagnose and help your child manage any loss of movement.

Other functions we often take for granted also are affected by damaged nerves. Among these are the ability to control the bladder and the flow of urine. When the nerves that normally control messages to start and stop the flow of urine do not work properly, it is called neurogenic bladder.

What are the signs and symptoms of a pediatric spinal cord injury?

If your child has immediate head, neck or back pain or has trouble with feeling or control in his or arms or legs, you should call 911 and avoid moving your child.

Trauma

The first sign of a spinal cord injury usually is trauma. Spinal cord injuries occur most often in major trauma, such as from a car accident or fall from height. Trauma to a child’s face, that causes the pelvis, or top of the hip bones, to fracture, or that penetrates the spine, can injure the spinal cord.

Other symptoms of a spinal cord injury include:

• Trouble walking or breathing

• Lumps along the spine or on your child’s head

Symptoms of a neurogenic bladder from spinal cord injury include:

• Retaining urine

• Frequent urinary tract infections

• Incontinence or leaking of urine

How is a pediatric spinal cord injury diagnosed?

A spinal cord injury may be diagnosed as part of an overall emergency assessment following trauma.

Usually, if an emergency doctor thinks your child has a spinal cord injury, the hospital performs emergency imaging including:

• Computed tomography (CT) 

• Magnetic resonance imaging (MRI)

• Myelogram

Neurological exam - Doctors perform complete neurological exams a few days after an injury occurs so they can assess how the injury affects the child’s ability to use muscles and feel sensations. They combine information from the neurological exam with information from imaging exams to assign a classification of the injury based on a standard scale.

Neurophysiological tests may check for evoked potential, or how well nerve signal pathways work through the spinal cord.

Urological testing - Urine samples and a test called a urodynamic study can be used to diagnose a neurogenic bladder. During the study, your child’s bladder is filled with saline, or a salt solution, to allow doctors to measure the volume, tone and pressure of the bladder, along with how well it contracts.

What are the causes of a pediatric spinal cord injury?

Most spinal cord injuries are caused by motor vehicle accidents. Using a seatbelt reduces your risk by more than half. Using an airbag and seatbelt reduces risk even more. Sports and recreational activities are also a major cause of spinal cord injuries in younger people.

How is a pediatric spinal cord injury treated?

Prevention

Wearing a seat belt and other proper restraints for a child’s age is one of the best prevention's for spinal cord injuries in children.

• Parents also can make homes safer from falls by removing tripping hazards and installing safety gates where appropriate.

• Experts caution that children younger than age one should not be carried on bicycles. They also encourage teens to use caution when skateboarding and bicycling, including use of helmets and avoiding use of headphones while on bikes.

• Parents should teach children and teens about safety around water to avoid accidents from diving and falling into pools and shallow bodies of water.

Emergency treatment - Call 911

When your child is injured and may have damage to his spinal cord, you need to seek emergency treatment. Call 911! Once emergency personnel and doctors assess the injury and stabilize your child’s spine, they will begin to evaluate health and movement problems your child might have as a result of the injury.

• Emergency personnel - The first treatment for spinal cord injury takes place where the accident occurs. Emergency personnel are specially trained to recognize possible neck and back trauma and to keep your child as still as possible, placing them on a special board for transport to the hospital.

• Emergency department - When your child arrives at the emergency department, doctors may use traction, surgery or special medication to help prevent further damage to the spinal cord.

Once your child is past the emergency stage, doctors treat the spinal cord injury depending on how severe the injury is and where it is located along the spine. Every child’s injury is different, and your child may need certain devices such as braces, or rehabilitation to help your child relearn how to perform some activities. 

Children who have problems with their bladder or urinary tract because of a spinal cord injury need help from a doctor to manage the flow of urine. Nerve damage can keep the bladder from emptying as it should. This can cause frequent urinary tract infections and kidney problems. Some children need specialized surgery or medications to help their bladders and urinary tract systems function as they should.

Surgery

Sometimes, doctors must insert catheters or perform a vesicostomy, which is an opening in your child’s lower abdomen to allow urine to flow.

At Children’s Health, our urology team can use a robot to operate in very small spaces, which means a smaller incision, and a way to help children empty their bladders on their own.