About spinal cord injuries
The spinal cord serves not just one critical function, but several. A compact but extremely powerful package of nerves, it works with the brain to transmit important messages that are responsible for functions in every area of the body.
Anatomy of the spinal cord
To understand how and why spinal cord injuries have different effects on different parts of the body, it’s helpful to understand the anatomy of the surrounding area. The spinal cord is divided into sections that correspond with the neighboring bones of the spine:
- cervical (neck area)
- thoracic (mid-back)
- lumbar (lower back)
- sacrum (base of the spine)
Typically, the higher the location of the injury, the more significant the resulting damage. Serious SCIs are categorized as either paraplegic — resulting in a loss of sensation and function in the lower half of the body — or quadriplegic/tetraplegic, resulting in a loss of feeling and movement from the chest down, including both arms and both legs.
Types of spinal cord injuries
Because the spinal cord plays such an essential role, any injury has the potential for widespread and serious damage. Spinal cord injuries (SCIs) can occur as:
- bruises (called contusions)
- partial tears
- complete tears (called a transection)
In addition, SCIs can be:
- incomplete, causing only a partial loss of feeling and movement below the level of the injury
- complete, causing a complete loss of sensation and function below the level of the injury
Spinal cord injury statistics
- Children account for 5 percent of all individuals who sustain spinal cord injuries.
- 60 to 75 percent of all SCIs occur in the neck area.
- 20 percent of all SCIs affect the chest or upper back.
- The remaining 5 to 20 percent involve the spinal cord in the lower back.
While treatment options depend on the specifics and severity of the particular injury, you can rest assured that Boston Children’s Hospital has the world-renowned expertise and state-of-the-art tools to give you, your child, and your family the care you need.
How is a spinal cord injury defined?
A spinal cord injury is any damage to the spinal cord that is caused by trauma, rather than a birth defect or medical condition that involves the spinal cord (such as a spinal cord tumor or tethered spinal cord syndrome).
Spinal Cord Injury | Symptoms & Causes
What are the symptoms of a spinal cord injury?
The exact symptoms your child experiences will depend on the degree of severity and particular location of her SCI.
Right after the trauma, she may go through spinal shock — a pronounced loss of feeling, muscle movement, and reflexes below the level of her injury. This is caused by swelling. In the case of minor SCIs (such as bruises), spinal shock can subside over the next couple of days as the swelling goes down, and some or all sensation and functions may gradually return.
When a SCI is more severe, however, other symptoms will start to emerge. These can include any or all of the following, depending on the location of the injury:
- Muscle weakness
- Partial or complete loss of muscle movement in the chest, arms, or legs
- Breathing difficulty
- Partial or complete loss of feeling in the chest, arms, or legs
- Loss of bowel and bladder function
In general, the higher in the back or neck the injury is located, the more extensive the symptoms will be. For example, if your child’s injury is in the lower portion of her spinal column, she may have reduced or absent feelings in (and impaired control of) her legs, bladder, and bowels. If her SCI is in the upper neck region, she may be unable to move her arms or legs or to breathe on her own.
SCIs can be severe and potentially life-threatening injuries. You should always seek immediate help for your child from trained, qualified emergency medical responders.
What causes spinal cord injuries in children?
Virtually any type of trauma can result in a SCI. Some of the most common traumatic situations children experience are:
- Falls
- Motor vehicle accidents (either with the child riding as a passenger or struck as a pedestrian)
- Sports injuries
- Child abuse or other incidences of violence
Spinal Cord Injury | Diagnosis & Treatments
How are spinal cord injuries diagnosed?
In many cases, the full extent of a child’s spinal cord injury isn’t obvious right away. That’s why it’s crucial that you obtain a diagnosis from a qualified medical professional as soon as possible.
Here at Boston Children’s, our trauma specialists will perform a comprehensive physical exam on your child and obtain a detailed account of how and where his injury occurred.
Next, doctors may order any or all of the following:
- Blood tests
- X-rays, which use small doses of radiation to take pictures of a part of the body
- Magnetic resonance imaging (MRI), a combination of electromagnets, radio frequency waves, and computers that takes two- and three-dimensional images of the spine and other body structures
- Computed tomography (CT) scans, a non-invasive procedure that uses X-ray equipment and powerful computers to create detailed images of the spine, spinal cord, and other body parts
How are spinal cord injuries treated?
Like the injuries themselves, the treatment options for SCIs are very specific to the individual child. Your child's treatment team will develop a customized care plan according to:
- The type and location of spinal cord injury your child has sustained
- The extent of the injury
- The extent of complications your child is experiencing your child's age, overall health, and medical history
- Your child's tolerance for particular medications, procedures, or therapies
- Your family's preferences for treatment
Prior to treatment: Immobilizing the head and neck at the time of the injury
A known or suspected spinal cord injury requires emergency medical attention at the scene.
While you or other bystanders are waiting for emergency personnel, it's imperative to keep your child's head and neck immobilized. Although the impulse to cradle and comfort the child, or to move him to a different position or place, is understandable, it is essential that he not be moved by anyone other than trained medical personnel.
Hospitalization and observation
Any SCI calls for a period of hospitalization, ranging from weeks to several months. Your child will most likely be admitted to the Intensive Care Unit (ICU), where a multidisciplinary team of clinicians will observe him, evaluate his progress and attend to all of his medical needs while helping you plan for the future.
Here at Boston Children's, your child's treatment team will include some or all of the following:
- Neurological and neurosurgical professionals
- Orthopedic professionals
- Trauma and emergency medicine professionals
- Pain treatment professionals
- Nurses who specialize in SCIs
- Respiratory professionals
- Physical therapists
- Occupational therapists
- Psychologists and social workers
All members of the team will work closely together, and will include you and your family in every aspect of the treatment process.
Surgery for spinal cord injury
While no surgical procedure can reverse or otherwise “fix” a spinal cord injury, surgery can sometimes be beneficial by allowing doctors to:
- Stabilize any spinal fractures
- Releasing pressure on the spinal cord
- Treating any other injuries that occurred at the same time as the SCI
Post-hospital visit care for spinal cord injury
Medication for spinal cord injury
Some medications can be helpful in:
- Reducing swelling around the spinal cord injury
- Controlling pain
- Managing spasticity (involuntary muscle contractions)
- Improving bowel and bladder control
Wheelchairs and other mobility assistance devices
Children whose spinal cord injuries affect their arm and/or leg function benefit greatly from wheelchairs. A wheelchair can make great strides possible in day-to-day living, travel, socialization, and even sports.
Breathing support
Children who have sustained a spinal cord injury in the neck area may lose some or all ability to breathe on their own. They may need a machine called a ventilator, which takes over breathing functions by pumping oxygen into the child's lungs and clearing out carbon dioxide.
Bowel and bladder support
Some SCIs can cause a temporary or permanent loss of bowel and bladder control. Urodynamic studies may be performed after the injury to measure how easily the child can empty his bladder (if at all).
There are several tools that can help a child manage incontinence, including Foley catheters, tubes placed into the bladder to drain urine. Once the child's condition stabilizes, catheterization can be done on a periodic basis to make sure his bladder is emptied while lessening the risk of an infection.
Feeding support
A child with a severe SCI that compromises his neck and throat muscles may have difficulty chewing and swallowing, putting him at risk for nutritional insufficiency.
A feeding tube — which is threaded from the nostrils down to the stomach, or directly into the abdomen to reach the stomach — is an effective way of ensuring the child consumes sufficient calories.
Rehabilitation
Physical therapy and other rehabilitation services are essential for any child with a spinal cord injury. The rehabilitation team will create a plan for your child that focuses on:
- Preventing muscle wasting
- Reducing spasticity
- Retraining the child to use other muscles that help with mobility and movement
Lifelong considerations for children with spinal cord injuries
Spinal cord injuries are often lifelong conditions for a child — and involve lifelong challenges for the entire family.
As difficult as coping with a serious SCI can be, it's important to remember that there is cause for hope: Regardless of the severity of your child's SCI, there are ways to maximize his capabilities at home, at school and in the community.
Positive reinforcement from you and other family members, combined with professional support services, will help your child strengthen his self-esteem and gain the greatest possible level of independence.
Neuromotor Therapy Program
Children who experienced a brain or spinal cord injury very early in life can have a variety of problems with their ability to move, and their needs change frequently as they get older. The Neuromotor Therapy Program at Boston Children's Hospital is devoted to maximizing the motor skills of these children.
Spinal Cord Injury | FAQ
The prognosis for a child with a spinal cord injury hinges on his exact injury — where in the spine it occurs, how serious it is and the specific symptoms it causes.
As a general rule of thumb, if a child shows rapid progress after a SCI, he has a better chance of making a more complete recovery.
Your child’s doctor is the best source of information about his situation and long-term outlook. The most important thing you can do for your child is to seek prompt medical attention from a qualified professional.
They are relatively rare, accounting for only 1 to 10 percent of all SCIs.
Unfortunately, there is no way to completely prevent a spinal cord injury: There is no equipment, device or safety gear that offers 100% protection.
However, there are several steps you can take to reduce the likelihood of your child suffering a spinal cord injury:
- Promote a safe playing environment, both in general play and recreation and in competitive sports.
- Always ensure that your child is wearing a seat belt, or properly secured in a car seat, whenever he is in the car.
Yes — this is very important.
It can be incredibly difficult for anyone witnessing a traumatic incident involving a child to resist the natural urge to intervene — either by picking up and cradling the child, or by otherwise moving him. However, keeping the injured child’s head and neck immobilized until medical help arrives is critical to avoid worsening the damage to his spinal cord.
The answer really depends on how badly your child’s spinal cord is injured and where in her neck or back the injury occurs. Some children with more moderate SCIs do regain feeling and function as the spinal cord heals.
Unfortunately, there is no cure at this time. However, Children’s researchers are hard at work in an effort to better understand the biological mechanisms involved in SCIs — and to discover how they might be reversed in the future, restoring partial or complete nerve and muscle functions. Learn more.
You and your family play an essential role in your child’s treatment for a spinal cord injury. It’s important that you share your observations and ideas with your child’s treating physician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.
You’ve probably thought of many questions to ask about your child’s injury and outlook. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you’ll have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you.
Some questions to ask your doctor might include:
- Where in my child’s spine is the injury located?
- Is the injury quadriplegic or paraplegic? Complete or incomplete?
- Is there any chance that he will regain lost sensation/function?
- Is surgery necessary?
- What medications will he need?
- Will he require a wheelchair or ventilator?
- What is the long-term prognosis for my child?
- How should I explain my child’s SCI to him? To friends, classmates, and family members?
- How will the injury affect my child’s home and school life?
- What changes do I need to make to my child’s daily routines?
- How can physical therapy, occupational therapy, and counseling help my child and family?
- What other resources can you point me to for more information?
