When your child says or does something puzzling, do you sometimes wonder what she’s thinking? Have you ever said to yourself, “I would never say or do something like that”?
As adults, we have grown-up ways of doing things, and we expect our children to think and behave the way we do at times. Yet kids are not little adults; they think and behave differently.
Children are different from adults in other ways too. For one thing, their bodies vary greatly from those of adults. Different bodies have different needs, and this is particularly important when kids are sick or injured. Doctors who see a lot of children take this into account when planning their treatment.
The unique challenge of treating children was the subject of a recent article by pediatric neurosurgeon Dr. Richard C.E. Anderson, from Columbia University Medical Center/Morgan Stanley Children’s Hospital of NewYork-Presbyterian. Together with Columbia neurosurgery resident Dr. Hannah E. Goldstein, Dr. Anderson reported on how surgeons manage injuries of the spine in children.
The spine is made up of a number of smaller bones called vertebrae. The vertebrae are connected by groups of tough fibers, or ligaments.
One of the most important functions of the spine is to protect the spinal cord, a column of nerves that runs inside the spine and connects the brain with nerves traveling to and from the rest of the body. The spinal cord carries the brain’s messages telling the body to move, as well as the body’s messages to the brain regarding sensation.
Because the spinal cord serves this important role as the body’s messenger, an injury to the spine—the ligaments and bones that protect the cord—can be devastating. Although a milder injury might show up as just neck pain, more serious injury—for example, a severe auto accident or fall—can cause the spinal cord to stop functioning, leading in extreme cases to paralysis or even death.
Although spinal injuries are fortunately much less common in children, those that do happen are more likely to affect the upper, or cervical, spine. Since this is the area where the spinal cord exits the brain, more critical nerves can be affected by a severe injury.
In addition, children are more likely to injure the ligaments of the spine than the bones, or vertebrae. What this means is that the bones can move out of alignment with one another more easily than they can with adults. This process, called subluxation, can damage the spinal cord.
Finally, because young children’s verbal skills are not fully developed, pediatric neurosurgeons realize that many children can’t tell them what’s going on. Doctors must use other clues—the type of injury or the results of a careful neurological examination, for example—to decide who may need further tests and treatment.
Testing generally involves x-ray studies such as a plain films of the cervical spine, and/or a CT or MRI scan. Many of these necessary tests involve exposure to radiation or general anesthesia, which can be particularly concerning in young children. Thus, doctors carefully consider patient characteristics in order to see who will benefit from the tests.
It appears that older, alert children without tenderness over the upper cervical spine can often be watched without further testing. Younger children, however, often need further examination and closer observation before it’s determined that they’re okay.
Doctors can often treat children without surgery by using external stabilization devices, such as a rigid cervical collar or a halo. A halo keeps the spine straight with screws attached to the skull. However, it is important to note that devices like these that are used on adults don’t always work as well for children.
For pediatric patients who do need surgery, the surgeon may use a process called fixation, which literally holds the vertebrae in place with screws and rods. Or they may perform a procedure called fusion, in which a piece of bone is grafted onto the vertebra and ultimately grows with it into a stable bone.
However they treat our young patients, Drs. Anderson and Goldstein conclude, success rates are high. They are able to achieve their goal of stabilizing the spine while preserving its ability to grow with the child.
Read the article abstract here.
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