Spine Trauma in Children

Perhaps the most significant difference between the pediatric and adult spines is the marked increase in elasticity in the spine of the growing child. The bones and ligaments of the child’s spine can tolerate up to four times as much stretch as the spinal cord they contain. This may be the explanation for the clinical entity know as SCIWORA, an acronym for “Spinal Cord Injury Without Radiographic Abnormality.” This self-explanatory entity should be suspected in the child presenting with the signs and symptoms of complete cord injury in the absence of evidence on imaging.

As well, as the energy is better dissipated through the more elastic structural elements, injuries to multiple contiguous vertebral segments can be seen. This is rather uncommon in adult populations.

Children with injuries involving apparent dislocations can often be treated non-operatively, when the adult counterpart injuries should be addressed surgically. This is secondary to an entity known as a periosteal tube fracture, whereby the integrity of the periosteal sleeve containing the displaced ossification center is preserved. This allows appropriate healing, and may help avoid spinal fusion and the undesirable sequelae thereof.

Generally, if growth plates are not damaged, reconstitution of injured vertebral bodies has been known to occur. Long-term bracing is relatively well tolerated by children, and can be helpful. Surgery is generally reserved for late deformities as a result of posttraumatic paralysis and spasticity. Such spastic deformities are particularly common in children under ten.