High Rates of Neurological Improvement Following Severe Traumatic Pediatric Spinal Cord Injury

Abstract

Study Design. 

Retrospective single-center study

Objectives. 

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

Summary of Background Data. 

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.

In Brief

The natural history and long-term outcome of pediatric spinal cord injury were investigated in this single-institutional retrospective study. The authors identified a high rate of improvement following mild or moderate neurologic injuries in concordance with previous studies, and 46% of surviving patients with complete injuries made functional gains in the long term. These findings are encouraging and support the aggressive treatment of children with complete injuries.