Spinal cord injury is a serious condition that is fortunately very rare, especially in children. Children have the peculiarity that a significant percentage of the spinal cord injuries occur without injuries in typical tests that are done in the emergency room such as X-rays or the scanner (CAT). These types of lesions are called SCIWORA (Spinal Cord Injury without Radiographic Abnormality). They are the abbreviations in English that describe a spinal cord injury without anomalies in the x-rays. Then we will see the importance of this fact.
Children have a developing anatomy and their spine is different from that of an adult. Let’s go see it:
– They have a big head for the body they have. This leaves the neck at a greater disadvantage than an adult.
– The musculature of the neck of the child is weak and immature, reason why it has greater difficulty to absorb the sudden mobilizations of the head.
– The ligaments and joint capsule of the different joints of the vertebrae are more lax and elastic than in the adult. Greater distension can occur without injuring the ligament. This implies being able to have a hypermobility that damages the marrow without causing great damages in the column.
These characteristics make a child who suffers a head fall, such as a dive or a somersault, and makes a sudden movement of the neck, for example, may have a spinal cord injury without suffering a significant injury to the vertebrae or ligaments Of the neck. In the dorsal column the risk is not so great because the vertebrae are also held by the ribs and are more stable. In the lumbar area SCIWORA is exceptional.
All of this is important because of the following. If our son or daughter has a fall with forced postures of the neck or spine, and has noticed weakness in the legs or tingling in the arms and / or legs we must take seriously to an emergency service. Even if those symptoms subside you may have suffered a bone marrow injury. It must be taken into account that 25% of these children develop the spinal cord injury in a delayed way over the following days.
Physical examination in the emergency room is essential to suspect an injury. The pain in the middle of the back of the neck when we palpates makes the doctors be cautious, put a collar and monitor the evolution. If there is no significant damage within a few days the child will move the neck perfectly painlessly and the collar can be removed. If there is an injury, the pain and limitation will persist but with the collar we will protect the neck so that the injury does not go any further while we perform more tests.
In more serious injuries we will not have these doubts and the injuries will be evident. It is important to pay attention to the less obvious ones and to detect them that may go unnoticed. In this sense, the transitory neurological symptoms such as the tingling or weakness in the arms and legs that appear after the accident are very important. In these cases, an MRI is often performed because this test does see most of the spinal cord injuries and complications that may require urgent action so that the injury does not go further.
In short, if our child suffers a fall or any type of accident involving forced postures of the spine, especially if it involves the neck, requires that we take you to an emergency room. This is all the more reason if after the blow you have noticed weakness or tingling in your arms and legs. If you wear a collar, even if you see it well, you should not take it off until your doctor reviews it again in successive days.