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Spinal cord injury in children: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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[ What causes spinal injuries in children?
The main type of violence is bending as a result of a fall from a height or a weight falling from above onto the victim's shoulders. A more common clinical form of spinal trauma is compression wedge-shaped fractures of the vertebral bodies. Much less common are fractures of the spinous and transverse processes, and very rare are isolated fractures of the arches. According to research, out of 51 injured children with spinal injuries, only one had an isolated fracture of the arch, while 43 children had compression fractures of the vertebral bodies. Most often, fractures are localized in the mid-thoracic region. More often, there are not single, but multiple fractures. The above-mentioned features are explained by the anatomical and functional features of the child's spine and by the features of the child's relationship with the external environment.
Spine in children: anatomical and functional features
The child's skeleton is richer in organic substances, which gives it considerable flexibility and elasticity. The bodies of its vertebrae contain a large amount of cartilaginous tissue, grouped in the area of growth zones. The smaller the child, the less spongy bone is contained in the body of its vertebra. Well-defined, high, elastic intervertebral discs with high turgor are excellent shock absorbers that protect the bodies of the vertebrae from the effects of external violence. The middle thoracic intervertebral discs have the smallest relative height. According to A. I. Strukov, in the bodies of the upper and middle thoracic vertebrae, the bone beams are located predominantly vertically and have short horizontal anastomoses, while in the bodies of the lower thoracic vertebrae, the network of vertical beams is closely intertwined with an equally well-defined network of horizontal beams, which gives the bodies of the lower thoracic vertebrae greater strength. Finally, the bodies of the middle thoracic vertebrae are located at the apex of the physiological thoracic kyphosis. These three anatomical prerequisites - the lower height of the intervertebral discs, the architecture of the vertebral bodies, the location at the height of the kyphosis - are the cause of the most frequent fractures of the bodies of the middle thoracic vertebrae.
The anatomical features of the vertebral bodies of the child are also reflected in spondylograms. According to the data of V. A. Dyachenko (1954), the vertebral bodies of the newborn are ovoid in shape and are separated from each other by wide intervertebral spaces, which in the lumbar region are equal to the height of the bodies, and in the thoracic and cervical regions are somewhat less than the height of the bodies of the corresponding vertebrae.
On the profile spondylogram of children of this age, strictly in the middle of their dorsal and ventral surfaces, there are characteristic slit-like notches, reminiscent of the lips of a closed mouth (G. I. Turner). These depressions are the entry point of intersegmental vessels, mainly vv. basivertebrales. In later periods of a child's life, these slits are determined only on the ventral surface of the bodies. In the lower thoracic and upper lumbar vertebrae, these slits can be traced up to 14-16 years.
In a child aged 1.5-2 years, on a profile spondylogram, the vertebral bodies appear as regular quadrangles with rounded corners. Subsequently, the rounded edges of the vertebral bodies undergo changes and acquire a stepped shape, which is due to the formation of a cartilaginous ridge. Such "stepped" vertebrae are observed in girls up to 6-8 years old, in boys - up to 7-9 years old. By this age, additional ossification points appear in the cartilaginous ridges, which, according to S. A. Reinberg, become visible radiographically at the age of 10-12 years.
They are most clearly expressed in the anterior sections. Their appearance is highly variable both in terms of timing and localization. Complete ossification of these cartilaginous ridges is detected by the age of 12-15, partial fusion with the vertebral bodies by the age of 15-17, and complete fusion with the vertebral bodies by the age of 22-24. At this age, the vertebral bodies appear as a rectangular quadrangle on spondylograms, and on the posterior spondylogram, the surfaces of this rectangle are somewhat depressed.
Symptoms of spinal injury in children
Clinical diagnosis of spinal fractures in children can be difficult due to the ingrained notion that spinal fractures in childhood are almost never encountered.
A carefully collected anamnesis and detailed clarification of the circumstances of the injury will allow one to suspect the presence of a fracture. The doctor's attention should be drawn to such information from the anamnesis as a fall from a height, excessive bending during somersaulting, falling on the back. When falling on the back, a flexion compression fracture of the vertebral bodies is apparently explained by an instant reflex bending of the upper part of the body, which leads to compression of the bodies. This moment of forced bending in the anamnesis is difficult to identify, since it goes unnoticed by the victim and usually does not appear in his story.
Typically, children experience uncomplicated, milder forms of spinal injury.
The most typical complaint of victims is pain in the area of the spinal injury. The intensity of this unprovoked pain in the first hours after the injury can be significant and pronounced. The pain increases with movement.
During examination, abrasions and bruises of various localizations may be noted. Usually, the general condition of the victims is quite satisfactory. In some, very rare cases, paleness of the skin and increased heart rate are noted. With damage to the lumbar vertebrae, there may be abdominal pain, tension of the anterior abdominal wall. Of the local symptoms, the most constant are local pain, which increases with movement and palpation of the spinous processes, as well as varying degrees of limitation of spinal mobility. Axial load on the spine causes pain only in the first hours and days after the injury. On the 2nd-3rd day, this symptom, as a rule, is not detected.
There may be rapidly passing radicular pain and symptoms of spinal cord concussion. In a significant number of cases, all these symptoms disappear by the 4th-6th day, and the condition of the injured child improves so much that the doctor does not think about a spinal injury.
Fractures of the transverse processes are characterized by limitation and pain when moving the legs, pain when trying to change position in bed. Fractures of the spinous processes are characterized by the presence of abrasions and bruises at the level of the fracture, local pain, sometimes the mobility of the broken process is determined.
Diagnosis of spinal trauma in children
In diagnostics of compression fractures of vertebral bodies in children, spondylography is of particular importance, as it is often the only way to make a timely and correct diagnosis. The most reliable radiographic symptom of a compression fracture of a vertebral body is a decrease in the height of the body of the fractured vertebra. This decrease may be very unconvincing and controversial, barely noticeable, but it may also be significant, up to a decrease in the height of the body by half its normal height. The decrease in height may be uniform, covering the entire length of the body, or limited to its ventral parts. The decrease in height may be observed as a bevel of the endplate with some apparent compaction due to the crushing of the subchondral bone layer. Compaction of the bone trabeculae of the vertebral body may be observed. Sliding of the endplate forward, more often cranial, with the formation of a protrusion is observed. A. V. Raspopina described a symptom of an asymmetrical location of the vascular gap or its disappearance on the fractured vertebra. All these symptoms are revealed on a profile spondylogram. Anterior spondylogram has significantly less diagnostic value.
In differential diagnostics, one should remember about congenital wedge-shaped vertebrae, apophysitis and some other anomalies of vertebral development, which can be mistaken for fractures.
When performing X-ray diagnostics of fractures of the transverse and spinous processes, one should remember about additional ossification points, which can be mistaken for fractures.
Treatment of spinal trauma in children
Treatment should provide relief of the broken vertebral bodies and prevent their further deformation. With proper and timely treatment, the shape of the broken vertebra is restored. The smaller the child, the more pronounced the growth potential, the faster and more complete the restoration of the anatomical shape of the broken vertebra. Usually there is no need to anesthetize the broken vertebral body, since in children this procedure is much more painful than the pain they experience.
The treatment consists of placing the injured child on a hard bed in a supine position with light unloading by traction on an inclined plane with traction for the armpits. Dense bags for reclination are placed under the fracture area. Children require constant attention from the staff, since they consider themselves healthy quite quickly after the pain disappears and do not comply with the treatment regimen. They can also be placed on a soft bed in a prone position. It is better to combine these two positions. A change of position brings variety to the child's life, and he more easily puts up with being forced to stay in bed. From the first days, therapeutic exercises are carried out according to the complexes described above.
The length of the child's stay in bed depends on the degree of compression of the fractured body, the number of damaged vertebrae and the age of the victim. This period varies from 3 to 6 weeks. The child is transferred to a vertical position in a special reclining lightweight corset. Children should be kept from sitting as long as possible. The period of wearing the reclinator and doing therapeutic exercise is on average 3-4 months. They should be individualized in each individual case and are dictated by the child's well-being and the data of control spondylography. In case of fractures of the processes, treatment is carried out by rest on a hard bed for 2 weeks.
In these cases, the entire range of necessary treatment should be carried out according to the relevant indications. In complicated fractures and dislocations, there may be a need for closed reduction of the displaced vertebrae, revision of the contents of the spinal canal, and surgical stabilization of the spine. Stabilization, depending on the level and nature of the displacement, as well as the return of patients, is carried out either by wire suture, or metal plates with bolts, or plates with bolts in combination with posterior spondylodesis. In each individual case, all these issues are resolved strictly individually, taking into account the characteristics of a particular patient.
Therefore, spinal fractures in childhood have a number of features that are determined by the anatomical and physiological characteristics of the structure of the child's spine. At the same time, children may also have "ordinary" spinal injuries typical of adults, which should be treated with appropriate methods and techniques, taking into account the characteristics and differences of the child's body.