Çocuklarda Travmatik Spinal Kord Hasarı
Özet
Çocukluk döneminde travmatik spinal kord yaralanmaları, anatomik farklılıklar ve yüksek esneklik nedeniyle erişkinlere göre daha nadir görülse de, servikal bölgede hasar riski oldukça yüksektir. Yaralanmalar sıklıkla trafik kazaları ve spor faaliyetleri sonucu oluşurken, radyolojik bulgu vermeyen ancak ciddi nörolojik hasara yol açan (SCIWORET) durumlar özellikle 8 yaş altı çocuklarda dikkatle değerlendirilmelidir. Tedavi süreci genellikle konservatif yöntemlerle yönetilse de, unstabil vakalarda ve ilerleyici nörolojik kayıplarda cerrahi müdahale gereklidir; ayrıca eşlik eden iç organ yaralanmaları mutlaka göz önünde bulundurulmalıdır.
Traumatic spinal cord injuries in childhood are rarer than in adults due to higher trauma tolerance and flexibility, yet they carry a higher risk of cervical region damage. While injuries commonly stem from traffic accidents and sports activities, cases like SCIWORET, where significant neurological damage occurs without radiographic findings, require careful assessment, especially in children under 8 years old. Although management is generally conservative, surgical intervention is necessary for unstable injuries and progressive neurological deficits, while concurrent internal organ injuries must always be evaluated.
Referanslar
Dias MS: Traumatic brain and spinal cord injury. Pediatr Clin N Am 51:271-303, 2004
Grabb PA, Hadley MN: Spinal column trauma in children. In: Albright L, Pollack I, Andelson D (eds), Principles and Practice of Pediatric Neurosurgery. New-York: Thieme Medical Publishers Inc, 1999:935-953
Loder RT, Hensinger RN. Fractures of the thoracic and lumbar spine. In: Beaty JH, Kasser JR (Eds.). Rockwood and Wilkins’ Fractures in Children. Lippincott Williams &Wilkins, Philadelphia 2001; pp:847-880.
Boese CK, Oppermann J, Siewe J, Eysel P, Scheyerer MJ, Lechler P. Spinal cord injury without radiologic abnormality in children: a systematic review and metaanalysis. J Trauma Acute Care Surg 2015; 78(4): 874-882.
Dimeglio A, Bonnel F, Canavese F. Normal growth of the spine and thorax. In: Akbarnia BA, Yazici M, Thompson GH (Eds.). The growing spine. Management of spinal disorders in children. 1st edition, Springer Verlag, Berlin Heidelberg 2011:11-40.
Kim YM, Kim DS, Choi ES, Shon HC, Park KJ, Cho BK, Jeong JJ, Cha YC, Park JK. Nonfusion method in thora- columbar and lumbar spinal fractures. Spine 2011; 36: 170-176.
Canosa-Hermida E, Mora-Boga R, Cabrera-Sarmiento JJ, Ferreiro-Velasco ME, Salvador-de la Barrera S, Rodríguez-Sotillo A, Montoto-Marqués A. Epidemiology of traumatic spinal cord injury in childhood and adolescence in Galicia, Spain: report of the last 26-years. J Spinal Cord Med 2017;23:1-11.
Bailey DK. The normal cervical spine in infants and children. Radiology 1952; 59: 712-719.
Carreon LY, Glassman SD, Campbell MJ. Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech 2004;17(6):477–482.
Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery 2004; 55: 1325-1342.
Dearolf WW 3rd, Betz RR, Vogel LC, Levin J, Clancy M, Steel HH. Scoliosis in pediatric spinal cord-injured patients. J Pediatr Orthop 1990; 10: 214-218.
Mayfield JK, Erkkila JC, Winter RB. Spine deformity subsequent to acquired childhood spinal cord injury. J Bone Joint Surg 1981; 63-A: 1401-1411.
Santiago R, Guenther E, Carroll K, Junkins EP Jr. The clinical presentation of pediatric thoracolumbar fractures. J Trauma 2006;60(1):187–192.
Louman-Gardiner K, Mulpuri K, Perdios A, Tredwell S, Cripton PA. Pediatric lumbar Chance fractures in British Columbia: chart review and analysis of the use of shoulder restraints in MVAs. Accid Anal Prev 2008;40(4):1424–1429.
Sledge JB, Allred D, Hyman J. Use of magnetic resonance imaging in evaluating injuries to the pediatric thoracolumbar spine. J Pediatr Orthop 2001;21(3):288–293.
Eleraky MA, Theodore N, Adams M, Rekate HL, Sonntag KHV: Pediatric cervical spine injuries: Report of 102 cases and review of the literature. J Neurosurg 92(suppl 1):12-17, 2000
Lustrin ES, Karakas SP, Ortiz AO, Cinnamon J, Castillo M, et al: Pediatric cervical spine: Normal anatomy, variants, and trauma. Radiographics 23:539-560, 2003
Turgut M, Akpinar G, Akalan N, et al: Spinal injuries in the pediatric age group: A review of 82 cases of spinal cord and vertebral column injuries. Eur Spine 5:148-152, 1996
Roth EJ, Park T, Pang T, Yarkony GM, Lee MY. Traumatic cervical Brown-Sequard and Brown-Sequard-plus syndromes: the spectrum of presentations and outcomes. Paraplegia. 1991 Nov;29(9):582-589.
Pang D, Wilberger JE Jr: Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57(1):114-129, 1982
Keleş I. Pediyatrik medulla spinalis yaralanmalarında epidemiyoloji ve patofi zyoloji. Turkiye Fiziksel Tıp ve Rehabilitasyon Dergisi 2008; 54:46–50.
Spinal injury: Assessment and initial management. National Institute for Health and Care Excellence. NICE Guideline 41, 2014:1-24
Rekate HL, Theodore N, Sonntag VK, et al. Pediatric spine and spinal cord trauma. State of the art for the third millennium. Childs Nerv Syst 1999; 15: 743- 750.
Pollack IF, Pang D, Sclabassi R: Recurrent spinal cord injury without radiographic abnormalities in children. J Neurosurg 69:177-182, 1988
Khan AA, Mahmood S, Saif T, Gul A. . Spinal cord injury without radiographic abnormality (SCIWORA) in adults: A report of two cases. J Pak Med Assoc. 2017;67(8):1275-1277.
Kalra V, Gulati S, Kamate M, Garg A. Sciwora-spinal cord injury without radiological abnormality. Indian J Pediatr2006; 73: 829-831.
Ergun A, Oder W. Pediatric care report of spinal cord injury without radiographic abnormality (SCIWORA): case report and literature review. Spinal Cord 2003; 41: 249-253.
Liao CC, Lui TN, Chen LR, Chuang CC, Huang YC. Spinal cord injurywithout radiological abnormality in preschool-aged children: correlation of magnetic resonace imaging findings with neurological outcomes. J Neurosurg 2005; 103: 17-23.
Singh AP, Bharati S, Ahmed S, Mishra L, Singh KD. Spinal cord injury without radiographic abnormality. Indian J Crit Care Med 2006;10:187-190.
Sharma S, Singh M, Wani IH, Sharma S, Sharma N, Singh D. Adult spinal cord injury without radiographic abnormalities (sciwora): clinical and radiological correlations. J Clin Med Res 2009; 1: 165-172.
Elnady B, El-Morshidy E, El-Meshtawi M, Shawky A. Pediatric cervical spine injuries with neurological deficits, treatment options, and potential for recovery. SICOT J 2017;3:53.
