Acute spinal cord injury (SCI) is due to a traumatic injury that either results in a bruise (also called a contusion), a partial tear, or a complete tear (called a transection) in the spinal cord. SCI is a common cause of permanent disability and death in children.

What causes an acute spinal cord injury?

There are many causes of SCI in children. The more common injuries occur when the area of the spine or neck is bent or compressed as in the following:

• birth injuries, which typically affect the spinal cord in the neck area
• falls
• motor vehicle accidents (where the child is either riding as a passenger in the car or is struck as a pedestrian)
• sports injuries
• diving accidents
• trampoline accidents
• violence (gun shots or stab wounds)

• Sixty to 75 percent of SCI occur in the neck area.
• Twenty percent of SCI occur in the chest region or upper back.
• The remaining 5 to 20 percent affect the spinal cord in the low back.

SCI is classified according to the child's type of loss of motor (movement) and sensory function. The following are the main types of classifications:

• quadriplegia (quad means four) - involves loss of movement and sensation in all four limbs (arms and legs). Quadriplegia also affects the chest muscles and may require a mechanical breathing machine for the child.
• paraplegia (para means two like parts) - involves loss of movement and sensation in the lower half of the body (right and left legs). The symptoms of SCI may include:
• muscle weakness
• loss of voluntary muscle movement in the chest, arms, or legs
• breathing problems
• loss of feeling in the chest, arms, or legs
• loss of bowel and bladder function

Diagnostic tests may include:

• blood tests
• Acute Spinal Cord Injury
• x-ray - a diagnostic test that uses invisible electromagnetic energy beams to
• produce images of internal tissues, bones, and organs onto film.
• computerized tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

• your child's age, overall health, and medical history
• the extent of the SCI
• the type of SCI
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the SCI
• your opinion or preference

There is no cure to repair a damaged or bruised spinal cord. The severity of the SCI and the location determines if the SCI is mild, severe, or fatal.

Surgery is sometimes necessary to evaluate the injured cord, stabilize fractured back bones, preventing them from moving and making the injury worse, decompress (or release) the pressure from the injured area, and to manage any other injuries that may have been a result of the accident. Treatment is individualized depending on the extent of the condition and the presence of other injuries in the child

Treatment may include:

• observation and medical management in the intensive care unit
• medications, such as corticosteroids (to help decrease the swelling in the spinal cord)
• mechanical ventilator, a breathing machine (used to help the child breathe)
• Foley catheter - a tube that is placed into the bladder that helps to drain the urine into a collection bag. Sometimes, when there is a fracture of th pelvic bones, a catheter is placed into the bladder through the skin on the abdomen. This is called a "suprapubic catheter."
• feeding tube - placed through the nostril to the stomach or directly through the abdomen into the stomach to provide extra nutrition and calories for the child.

Some children may be able to empty their bladder as they regain function while others may not. Once the child has stabilized, the bladder catheter is removed and intermittent catheterization is started to insure complete emptying of the bladder with minimal risk of infection. Urodynamic studies are usually performed two months after the spinal cord injury to determine how easily the child empties the bladder and if this is accomplished at low pressures. Some children may wet themselves between catheterizations and urodynamics. This determines if medications are needed to prevent this from happening.

Rehabilitation focuses on preventing muscle wasting, and contractures, and works to retrain your child to use other muscles to aid in mobility and movement.

The disabled child requires a focus on maximizing his/her capabilities at home and in the community. Positive reinforcement will encourage him/her to strengthen his/her self-esteem and promote independence.

A child with a SCI requires frequent medical evaluations and diagnostic testing following hospitalization and rehabilitation to monitor his/her progress.