How is it possible that kids (even babies) can end up with a spinal cord injury? I thought this age group was pretty flexible, more like rubber and not quite rigid yet like adults.

Car accidents, falls from a height, and sports trauma are the three most common causes of such serious injuries in children. The lack of strength, increased laxity and mobility, and decreased spinal stability in children (as compared with adults) are additional reasons why pediatric and adult spinal injuries differ.

In children, ligamentous laxity in the spine is greater than the ability of the spinal cord to stretch. In other words, the ligaments can stretch with the force of the distraction from the injury but the spinal cord only has so much give before it is injured as well.

Likewise, the growth plate (physis) can be damaged but the discs and bony vertebra remain unharmed. The result can be a spinal cord injury without fracture of the surrounding bone. This type of injury has been reported in children as young as six months old resulting in permanent paralysis.

As with other pediatric injuries that can also affect adults, spinal injuries in the very young aren’t the same as in the fully grown adult. There are different anatomical features to consider along with differences in healing responses to trauma.

Two of the most important factors that influence the management and outcomes of serious spinal injuries include the extensive bone and soft tissue remodeling that goes on and the fact that the child is still growing. The growth factor alone can make deformities and complications better or worse.

A “serious” spinal injury has been described as vertebral fractures with or without dislocation and/or with or without spinal cord injury. Spinal cord injury without radiographic abnormality (SCIWORA) is the term used to describe spinal cord injury without bone fracture. And one of the later developments of a spinal cord injury in children without apparent bone involvement is spinal deformity (scoliosis). This type of subsequent deformity can be very severe.