Pediatric spins and spinal cord trauma - State of the art for the Third Millennium

The purpose of this work was to analyze the literature published in English and to review the experience of the Barrow Neurological Institute (BNI) wi th spine and spinal cord injury (SCI) in children. Standard computerized da ta bases were queried for information Regarding SCI, spinal injury, spinal instability, and spinal cord regeneration to produce a review of the epidem iology, diagnosis, treatment, outcome and directions for future research. W e also reviewed our experiences in the management of infants and children w ith spine injuries and SCIs and with spinal instability from all causes. A total of 132 articles were identified and obtained from the Medical Library at St. Joseph's Hospital and Medical Center in Phoenix, Ariz, and through interlibrary loan. All these articles were read, although not all were used in the final review. A review of all children with SCIs revealed that frac tures treated over the past 20 years at the BNI were very rare in preadoles cent children, who suffered mostly from ligamentous injury or SCI without r adiographic abnormality. A total of 68 children aged 16 years or younger wh o had been treated over the past 15 years and who had undergone spinal fusi ons for trauma, congenital anomalies, or tumor resection were identified. O ccipitocervical fusion is well tolerated in children as young as 11 months when internal stabilization with a threaded titanium rod is used, Posterior instrumentation, including pedicle screw fixation, is feasible in children as young as 4 years. Fusion techniques derived from the adult spinal instr umentation experience were found appropriate except for the youngest patien ts. Fusion in the newborn period was futile in our experience. The adolesce nt spine does not differ from the adult spine in terms of sensitivity or re sponse to fixation. Children past the neonatal period can be successfully i nstrumented for spinal stability without apparent long-term sequelae. Relat ed advances are needed in the area of prevention. Long-term advances in spi nal cord regeneration can be expected from ongoing basic science investigat ions.