Pediatric Spinal Cord Injury
The spinal cord is part of your child’s nervous system. It carries messages between the brain and the nerves throughout the body that control organs and muscles. If your child receives an injury to the spinal cord, any nerves in the cord from the point where it’s injured and below fail to work as they should.
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.
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.
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. Other symptoms of a spinal cord injury are trouble walking or breathing or lumps along the spine or on your child’s head. Symptoms of a neurogenic bladder from spinal cord injury are retaining urine, frequent urinary tract infections and incontinence, or leaking of urine.
Test and Diagnosis
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. Computed tomography, or CT, scans used X-rays and a computer to take detailed cross-sectional images of your child’s spine.
Magnetic resonance imaging (MRI) uses strong magnets, radio waves and a computer to create detailed images of the spine. X-rays of the spine can show damage or fractures. Some children might need a special type of X-ray exam called a myelogram that uses an injected dye to highlight areas on the images.
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.
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.
When your child is injured and may have damage to his spinal cord, you need to seek emergency treatment. 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.
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 her on a special board for transport to the hospital. 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.
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.
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 1 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.
What’s the most common cause of spinal cord injuries?
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.
Does everyone who has a spinal cord injury become paralyzed?
Each spinal cord injury is unique. Whether your child is paralyzed depends on how severe the injury is and where it occurs along the spine. Most people who have spinal cord injuries have tetraplegia (formerly called quadriplegia) of some form. This means they lose all or some movement below the neck level. Still, advances in treatment have meant that more people have incomplete tetraplegia. This means they retain some movement and function.
What do I do if I think my child has had a spinal cord injury?
If there is any chance that your child has seriously injured his head, neck or back, you should call 911. You also should avoid moving your child.
How do spinal cord injuries cause bladder problems?
Nerves control many functions in our body. Spinal cord injuries can damage the nerves that control the bladder and bowel. When this happens, your child needs help making sure that his bladder empties regularly. If it doesn’t, bacteria can build up and cause an infection. A pediatric urologist can look at several different solutions to help prevent bladder and kidney problems in your child with spinal cord injury and ways to help your child empty her bladder.
What research is being done on spinal cord injuries?
Public and private research is being conducted to help learn how to repair the spinal cord when it is damaged. Until researchers can accomplish this goal, they are looking at ways to improve rehabilitation so that more children with spinal cord injuries can walk or perform additional tasks for themselves. Research also continues on devices to better assist people with spinal cord injuries.
How well will my child recover from a spinal cord injury?
Doctors cannot completely predict how well your child will recover from a spinal cord injury. They can estimate how well your child will do based on the severity of injury, the location of the injury and whether it is complete or incomplete. Most children and teens with an incomplete injury can recover more function than those with complete injuries.