Spinal injury includes injury to the vertebral column and the spinal cord. In children, it accounts for 1% to 10% of total spinal injuries, and it is rarer in children below 5 years of age. Although not particularly common in children, spinal injuries may result in more serious complications in physical, social, and mental health when compared with adults. This is exacerbated by the extended years’ post-injury, thus creating an increased potential for severe limitations. In fact, spinal injury in children could occur without any evidence of bone or soft tissue injuries. Primary differentiating factors in children include injury mechanism, level of injury, and gender distribution. Pediatric spinal injuries are classified according to morphology into bony injuries, ligamentous injuries, bony and ligamentous involvement, and spinal cord injuries without bony or ligamentous abnormality (SCIWORA). Arresting further neurological deterioration and deformity improves chances of a good recovery in pediatric cases but timely identification and treatment of spinal injury are critical to the process. Pediatric patients with traumatic spinal cord injury (SCI) exhibit a more robust neurological recovery potential compared with adults owing to their unique mechanisms of injury. Uncovering further characteristics of SCI in children, which are not evident in the adult population, will lead to an enhanced understanding of pediatric SCI cases and improved patient outcomes. Therefore, the study was designed to analyze the epidemiological parameters and associated factors in children with SCI admitted at the Indian Spinal Injuries Center (ISIC) in the last 14 years.
A retrospective data analysis of pediatric cases (up to 18 years) with an SCI diagnosis was conducted for patients admitted at ISIC between 2002 and 2015. Children with birth injuries and other pathological anomalies were excluded.
Data including demographics and other details such as cause of spinal injury, neurological findings at admission, and discharge using the International Standards for Neurological Classification of Spinal Cord Injury—American Spinal Injury Association Impairment Scale (ISNCSCI-AIS), associated injuries, radiological findings, management received, steroids given, complications during hospital stay, and outcomes of the management were collected from medical records. The study was approved by the Institutional Ethics Committee of Indian Spinal Injuries Centre, New Delhi, India.
The subjects were divided into 3 age groups: I, II, and III, 0 to 9 years, 10 to 14 years, and 15 to 18 years, respectively, for a better understanding of prevalence and mechanism of various injury patterns and other factors with respect to age. The demographic and injury-related datasets were analyzed descriptively. The incidence, type, and level of injury were compared across the age groups using a χ2 test. Injury to the vertebral column was categorized into 4 types: fracture without subluxation or dislocation, fracture with subluxation or dislocation, SCIWORA, and dislocation or subluxation only. Wherever appropriate, Fisher exact test was used. The P value of <.05 was considered statistically significant. SPSS version 10 was used.
There were 1660 pediatric trauma cases admitted at ISIC between 2002 and 2015, of which 438 were in group I, 435 in group II, and 787 in group III. We identified 204 cases with spine injuries from the medical records. The average age of children with spine injury was 15.69 years, ranging from 3 to 18 years. There were 15 patients (3%) in group I, 27 patients (6%) in group II, and 162 patients (21%) in group III. This difference in spine injury incidence among the age groups was statistically significant (χ2 = 97.1, degrees of freedom = 2, P < .0001). Among the spinal injured, boys (77%) were more vulnerable to injury than girls (23%). Group-wise distribution of boys was 11, 22, and 124 and girls was 4, 5, and 38 in groups I, II, and III, respectively.
Table 1 describes the mode, level, and type of injury across the age groups. Fall from height (FFH) was the most common cause of spinal injury, followed by road traffic accidents (RTA). The cervical spine was the highest involved region followed by the thoracic and lumbar regions. Among cervical-level injuries, 9% of subjects had upper cervical and 91% had subaxial involvement. The occurrence of upper cervical injuries (occiput to C2) was the same across all age groups (3 cases each in groups I and III and 2 cases in group II). Group III showed a predominance of all regional-level injuries. The proportion of subjects with thoracic level involvement was same in both groups I and II. There was only one sacral injury in group III. Twenty (9.5%) children had junctional level injuries that are cervicothoracic and thoracolumbar injuries. The fracture was the most evident type of injury, with 57%, followed by a fracture with dislocation or subluxation and pure dislocation or subluxation injury, with 25% and 11% correspondingly.
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