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)

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

• 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.

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).

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.

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

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

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.

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.

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 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.

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.