KidsMD Health Topics

Spinal Cord Injury

  • 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.

    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)

    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:About 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.

    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

    Here are some of the statistics on spinal cord injuries:

    • Children account for only 5 percent of all individuals who sustain spinal cord injuries.
    • 60 to 75 percent of all SCI occur in the neck area.
    • 20 percent of all SCI 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 Children’s Hospital Boston has the world-renowned expertise and state-of-the-art tools to give you, your child and your family the care you need.

    How Children’s Hospital Boston approaches spinal cord injuries

    Learning that your child has a spinal cord injury is a frightening and potentially life-changing moment for any parent. Children’s Hospital Boston is here to work with you, your child and your family through every moment of your journey.

    Children’s Spinal Program is acclaimed both nationally and internationally for our excellence in diagnosing, treating and managing spinal cord injuries in children of all ages. In fact, our program:

    Working together, our clinicians will develop a customized treatment plan that meets your child's medical, emotional and practical needs—and involves you and your family at every step of the way.

    Children’s Injury Prevention Program

    It’s a sad fact that injury is the number one cause of death and disability among children in the United States.  Fortunately, most childhood injuries are preventable. Here at the Injury Prevention Program at Boston Children's Hospital, we’re committed to drastically decreasing the number of preventable injuries through education efforts and research. Learn more.

    Spinal cord injury: Reviewed by Mark R. Proctor, MD
    © Children’s Hospital Boston; posted in 2011

  • 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 cord syndrome).

    What are the different types of spinal cord injuries?
    Spinal cord injuries can vary in severity—from slight bruising to complete tears—as well as location. Serious injuries are classified according to the degree of lost movement and sensation they cause:

    • quadriplegic/tetraplegic (“quad” derives from the Latin word for “four” and ‘tetra’ derives from the word for five, implying loss of control of the trunk muscles) SCIs cause loss of movement and sensation in both arms and both legs. They also affect the muscles of the chest, meaning that a child with this type of injury may require mechanical support for breathing.
       
    • paraplegic (“para” comes from the Greek term for “half”) SCIs cause loss of motion and sensation in the lower half of the body, including the legs.
    Did you know?

    Children’s neurosurgery, neurology and orthopedics programs have been # 1 by U.S. News & World Report.


    Causes

    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
       

    Signs and symptoms

    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.           

    FAQ

    Q: Will my child be OK?
    A: 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.

    Q: How common are spinal cord injuries in children?
    A: They are relatively rare, accounting for only 1 to 10 percent of all SCIs.

    Q: Can spinal cord injuries be prevented?
    A:
    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:

    Q: Do I need to keep my child immobilized on the scene of his injury until help arrives?
    A: 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.

    Q: Is there any hope that my child will regain any degree of lost function over time?
    A:
    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.

    Q: Is there a cure for spinal cord injuries?
    A: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 in our “Research and Innovation” section
     

    Questions to ask your doctor

    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? 
  • How is a spinal cord injury 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 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-dimensional 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
  • What are the treatment options for a child with a spinal cord injury?
    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 Children's, your child's treatment team will include some or all of the following:

    All members of the team will work closely together, and will include you and your family in every aspect of the treatment process.

    Surgery
     

    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

    Medication

    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.

    Children's has a dedicated Center for Continence of Urine and Bowel (CUB) to assist with incontinence issues tied to a wide range of medical conditions.

    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 Children's Hospital Boston is devoted to maximizing the motor skills of these children. Learn more.

     

    Coping and support

    When your child has a spinal cord injury, your family is grappling with many concerns and questions. Not only are you focused on meeting all of your child's medical needs; you are also facing a significant emotional and psychological toll that can affect every member of the family.

    In addition to the clinical information offered on this page, Children's has several other resources designed to give your family comfort, support and guidance:

    Patient and family resources at Children's

    • Children's Center for Continence of Urine and Bowel (CUB) brings together experts in gastroenterology, general surgery, neurosurgery and urology to help children of all ages with bladder and bowel incontinence.
       
    • Our Neuromotor Therapy Program is devoted to assisting children with spinal cord injuries and other traumatic neurological injuries maximize their motor skills.
       
    • Children's Behavioral Medicine Clinic helps children who are being treated on an outpatient basis at the hospital—as well as their families—understand and cope with their feelings about:
    • being sick
    • facing uncomfortable procedures
    • handling pain
    • taking medication
    • preparing for surgery
    • changes in friendships and family relationships
    • managing school while dealing with an illness
    • grief and loss
       
    • Children's Psychiatry Consultation Service is comprised of expert and compassionate pediatric psychologists, psychiatrists, social workers and other mental health professionals who understand the unique circumstances of hospitalized children and their families. The team provides several services, including:
    • short-term therapy for children admitted to one of our inpatient units
    • parent and sibling consultations
    • teaching healthy coping skills for the whole family
    • educating members of the medical treatment team about the relationship between physical illness and psychological distress
       
    • The Experience Journal was designed by Children's psychiatrist-in-chief David DeMaso, MD and members of his team. This online collection features thoughts, reflections and advice from kids and caregivers about living with medical conditions and going through treatment.
       
    • Children's Department of Psychiatry publishes a free booklet, “Helping Your Child with Medical Experiences: A Practical Parent Guide”(.pdf file). Topics in the booklet include:
    • talking to your child about her condition
    • preparing for surgery and hospitalization
    • supporting siblings
    • taking care of yourself during your child's illness
    • adjusting to life after treatment
       
    • Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the Center's services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.
       
    • The Children's chaplaincy is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members—representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions—who will listen to you, pray with you and help you observe your own faith practices during your child's treatment.
       
    • Children's International Center is a dedicated resource for patients and families from countries outside the United States. The center can provide assistance with everything from reviewing medical records to setting up appointments and locating lodging. Contact the center by phone at 01-617-355-5209 or via e-mail at international.center@childrens.harvard.edu.
       

    Helpful links

    Please note that neither Children's Hospital Boston nor the Spinal Program at Children's unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.

  • At Children’s Hospital Boston, our care is informed by our research, and our discoveries in the laboratory strengthen the care we provide at each child's bedside. Children’s scientific research program is one of the largest and most active of any pediatric hospital in the world.

    In particular, our neurology, neurosurgery and orthopedics researchers are making new inroads in understanding the causes and progression of spinal cord injuries, paving ground for new treatments.

    Children’s researchers among team regenerating connections in injured spinal cords
    Researchers for the first time have stimulated regeneration of nerve tissue connections in injured adult spinal cord sites that control voluntary movement. These findings provide hope that it may be possible to design therapies for paralysis and other motor function impairments arising from spinal cord injury. Learn more.

    Stimulating regrowth of damaged nerve fibers
    Because injured neurons in the brain or spinal cord can't grow back, damage from a spinal cord injury, stroke or traumatic brain injury can't be repaired. But researchers led by Children’s neurologist Zhigang He, PhD,BM, have found a way to overcome natural inhibitory mechanisms that suppress regeneration, causing nerve fibers to re-grow. Learn more.

    Does an enzyme hold the key to regenerating damaged nerves?
    Researchers at Children's have discovered an enzyme (known as Mst3b) that may hold promise as a possible treatment for brain and spinal cord injury. Learn more.

    Cellular compound enhances motor function
    Children’s neurosurgery researcher Larry Benowitz, PhD, has found that inosine—a naturally occurring cellular compound—improves motor function after spinal cord injuries and strokes, and is pursuing potential treatments. Learn more.

     One man’s commitment to SCI research at Children’s
    Barry Siegel says he's living "life number two." Early one morning, while biking, Barry was hit by a motorist. Life number two began as a quadriplegic, and Barry became a passionate advocate for stem cell research. "After I got hurt, I was very interested in what I could do to help patients with spinal injuries." Read more.


    Clinical trials
     

    Children’s is known for pioneering some of the most effective diagnostic tools, therapies and preventive approaches in pediatric medicine. A significant part of our success comes from our commitment to research—and to advancing the frontiers of mental health care by conducting clinical trials.

    Children’s coordinates hundreds of clinical trials at any given time. Clinical trials are studies that may involve:

    • evaluating the effectiveness of a new drug therapy
    • testing a new diagnostic procedure or device
    • examining a new treatment method for a particular condition
    • taking a closer look at the causes and progression of specific diseases

    While children must meet strict criteria in order to be eligible for a clinical trial, your child may be eligible to take part in a study. Before considering this option, you should be sure to:

    • consult with your child’s treating physician and treatment team
    • gather as much information as possible about the specific course of action outlined in the trial
    • do your own research about the latest breakthroughs relating to your child’s condition

    If your physician recommends that your child participate in a clinical trial, you can feel confident that the plan detailed for that study represents the best and most innovative care available. Taking part in a clinical trial at Children’s is entirely voluntary. Our team will be sure to fully address any questions you may have, and you may remove your child from the medical study at any time.

    Children’s responds to treatment of first patient in SCI stem cell clinical trial
    A patient with spinal cord injuries, paralyzed from the waist down, became the first clinical trial subject to receive a treatment derived from embryonic stem cells. This is what stem cell researchers have been waiting for — a carefully regulated, science-based trial of a stem-cell-based therapy, in contrast to unproven stem cell “cures” offered by questionable U.S. and offshore clinics. The response from Children’s is one of cautious optimism. Read more.
  • Jared’s story

    Read more.

    Matt’s story

    Read more.

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