Traumatic spinal cord injury in children and adolescents: a 20-year review from the Hospital for Sick Children

OBJECTIVE Traumatic spinal cord injury (SCI) in children and adolescents is uncommon but represents a substantial source of morbidity. Due in part to its rarity, there are few pediatric-specific studies on this topic. Therefore, the aim of this study was to assess demographics, injury mechanisms, treatment characteristics, and neurological outcomes in a cohort of pediatric patients with traumatic SCI, and to determine patient and injury factors associated with neurological recovery after injury. METHODS In this retrospective observational cohort study, children and adolescents with traumatic SCI presenting to a quaternary children’s hospital from January 2000 to December 2020 were identified. Patients with spinal column injury without evidence of spinal cord involvement, such as fracture and ligamentous injury alone, were excluded. Neurological examinations were abstracted from clinical notes at admission, discharge, and 3- to 4-month and 12-month follow-up time points, and the grade of injury was assessed per the American Spinal Injury Association Impairment Scale (AIS). Univariate logistic regression was used to identify associations between demographic, injury, and treatment variables with improvement of ≥ 1 AIS grade at 12 months. RESULTS Seventy-five patients (45 male, mean age 10.4 years) with traumatic SCI were included in the analysis. The injury mechanism was most often motor vehicle collision (MVC; n = 35, 46.7%), followed by sports and recreation injuries (n = 23, 30.7%) and falls (n = 9, 12%). There were 36 patients (48%) with concomitant nonspinal injuries, including 24 (32%) with traumatic brain injury. Overall, 15 patients (20%) died in the hospital at a median of 1 day (IQR 1–2 days) after injury, most of which were associated with MVC, concomitant head injury, and/or craniocervical junction (CCJ) dissociation. Surgical intervention was performed for 30 patients (40%). Of the 47 patients with AIS grades A–D who survived to the 1-year follow-up, 34 (72%) improved by ≥ 1 AIS grade and 11 (23%) improved by ≥ 2 AIS grades by 12 months. A higher injury severity score (OR 0.86, 95% CI 0.77–0.93) and spinal cord hemorrhage on MRI (OR 0.09, 95% CI 0.01–0.58) were associated with lower odds of improvement. CONCLUSIONS Mortality was relatively common after pediatric SCI and was associated with CCJ dissociation or concomitant nonspinal injuries. Among surviving patients who were admitted to the hospital with neurological impairment, a majority experienced improvement by ≥ 1 AIS grade at the 12-month follow-up.