Pediatric Spinal Cord Injury
Level and mechanism differ from adults
Children under about 8 years have ligamentous laxity, horizontally oriented facet joints, and a proportionally large head, so upper cervical (C1-C2) injuries and atlanto-occipital disruption predominate. Spinal cord injury without radiographic abnormality (SCIWORA) is a pediatric diagnosis - the cord is injured but plain films are normal; MRI and immobilization are required, and delayed deterioration can occur. Adolescents shift toward adult-type lower cervical and thoracolumbar patterns.
Core rehabilitation content
Neurogenic bladder managed with clean intermittent catheterization, anticholinergics, and periodic urodynamics; a structured bowel program; skin protection with turning and pressure mapping; spasticity management; and contracture prevention. Autonomic dysreflexia occurs at T6 and above and can appear in young children - look for a blocked catheter, constipation, or a pressure injury when a child with high SCI has headache, sweating, or hypertension. Poikilothermia is common because of loss of sympathetic vasomotor and sweating control.
Late and growing-child complications
Neuromuscular scoliosis and hip subluxation progress with growth; bracing may slow but not prevent curves, and growing-rod or fusion decisions balance growth against deformity. Any new weakness, ascending sensory level, or spasticity change should prompt imaging for syringomyelia, tethered cord, or shunt malfunction. Immobilization osteoporosis makes the femur a common fracture site during transfers. Latex precautions remain standard.
Worked rule of thumb
A child with SCI and new neurologic deterioration gets MRI of the whole neuraxis before assuming "just spasticity" - syrinx, tethering, and hydrocephalus are the classic reversible causes.