Pediatric spinal cord injuries: anatomical differences bring different challenges with kids.
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Roughly 2,000 U.S. children experience spinal column injuries annually. However, thousands more present to emergency departments with mechanisms of injury that could injure their spine. When children can follow commands and understand questions, performing a careful and accurate spine assessment may eliminate the need for unnecessary spine immobilization. When a spine injury is suspected, proper pediatric immobilization requires careful control of the spine's weight centers and proper padding to ensure the spine remains in a neutral position.Keywords:
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PREFATORY REMARKS
In two former papers I have dwelt at length on the mechanical considerations of injury to the spinal cord in cases of fracture dislocation of the spinal column.1, 2 In this communication, therefore, I shall limit myself to the discussion of the experimental work in which I have been engaged for the past year in the laboratories of the University of Pennsylvania. I would accentuate the fact that this is a preliminary report and that I am fully aware of the amount of control experimentation necessary before anex cathedrastatement can be made as to applicability of this work in the human subject.MEASUREMENT OF IMPACT ON SPINAL CORD IN SPINAL FRACTURE DISLOCATION
In order to arrive at an adequate concept as to the amount of impact a spinal cord could receive and yet recover its function, I designed an instrument whereby a given weight couldSpinal column
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Abstract Abstract This paper describes the construction and validation of a physical model of the human cervical spinal column. The model incorporates a model spinal cord whose deformation may be measured during a simulated impact. The mechanical properties of the model spinal cord and the detailed kinematics of the spinal column were validated against human data in both flexion and extension. The model was then tested in simulated hyperflexion and hyperextension injuries and the cord strains and strain rates measured. In flexion, the strains were found to be in excess of critical values for isolated neural tissue damage. In extension the strains were found to be smaller, and less likely to cause injury in the absence of bony fracture or subluxation.
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Roughly 2,000 U.S. children experience spinal column injuries annually. However, thousands more present to emergency departments with mechanisms of injury that could injure their spine. When children can follow commands and understand questions, performing a careful and accurate spine assessment may eliminate the need for unnecessary spine immobilization. When a spine injury is suspected, proper pediatric immobilization requires careful control of the spine's weight centers and proper padding to ensure the spine remains in a neutral position.
Vertebral column
Spinal column
Spinal injury
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Spine injuries include injuries to the spinal column and also injuries to the neural structures including the spinal cord and nerve roots. The incidence of spinal cord injury is estimated at 30 to 40 per 1,000,000 persons. Spinal injuries are classified according to location and pattern of disruption of the ligaments and bony elements. Spinal cord injuries are classified according to the level and degree of function using the Frankel or ASIA score. Treatment of spine and spinal cord injuries includes the principles of realignment of the spine and protection of the spinal cord and nerve roots from injury or further injury. A combination of reduction, immobilization and often operative fixation are required to treat the gamut of injuries to the spine. It is important for physicians treating these patients to be familiar with the common and classic patterns of spinal column and spinal cord injuries and the treatment options for each. Pediatric patients represent a group at risk for certain types of injuries, due to unique biomechanical differences between the adult and the pediatric spine.
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The purpose of this presentation is to provide basic biomechanical information concerning the spine, its components, and the spinal cord. It is shown that this information is helpful in understanding the fundamental functions of the spinal column. The experimentally determined physical properties of the vertebra, various spinal ligaments, the disc, and the spinal cord under many different loading conditions are described. The role of the special characteristics of the spine ligaments in allowing physiological motions of the spine, preventing excessive motions between vertebrae, and protecting the spinal cord during trauma are discussed. Movements of the spinal cord within the spinal canal and associated changes of its section during physiological movements of the spine are also described. The kinematics of the various regions of the spine are discussed and their clinical significance is presented. The problems of spinal trauma and its associated spinal instability are analyzed. Guidelines are recommended to assess spinal stability. The proper application of such guidelines will provide the basis for sound clinical judgments. (Neurosurgery, 7: 76-93, 1980)
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A new model of spinal cord injury (SCI) has been developed in the rat, which produces axonal and vascular injury within the spinal cord through lateral displacement of the vertebral column. An electromechanical feedback-controlled device produces the injury by displacing the vertebral column to the left hand side. The speed and lateral displacement is controllable by the user, and the resulting injury ranges from no histologically evident injury, to total disruption of the vertebral column with associated widespread axonal and vascular damage. Histological and immunohistological techniques were employed to correlate mechanical parameters with the extent of pathological injury of spinal cord. Axonal injury was most severe in the left lateral white matter, and vascular injury was concentrated in the gray matter.
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27 albino-rats were used to measure the growth of skull, spinal column, spinal cord, roots of the spinal nerves, and length of tail and extremities at their 1st to the 5th, the 8th, 11th, 15th, and 20th postnatal day. The growth rate of the distal and caudal parts of the distal body was higher than of the cranial and proximal ones.
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