Öz
Giriş: Travmatik spinal kord yaralanması (SKY), çocuklarda nadir görülen bir antitedir. Çocuk omurgasındaki anatomik ve biyomekanik farklılıklar nedeniyle yaralanma paternleri, erişkinlere göre farklılık gösterir(1, 2).
Amaç: Travmatik SKY olan pediatrik hastaların sosyodemografik ve klinik özelliklerinin değerlendirilmesidir.
Materyal-Metot: Çalışma, retrospektif tanımlayıcı bir çalışma olarak planlandı. 18 yaş altı, travmatik SKY olan hastalar çalışmaya dahil edildi. Hastaların sosyodemografik ve klinik verileri, komplikasyonları ve rehabilitasyon sonuçları incelendi.
Bulgular: Ocak 2020-Ağustos 2022 tarihleri arasında başvurusu bulunan 13 kız, 19 erkek hasta çalışmaya dahil edildi. Ortalama yaş 151,96±52,81 aydı. Ortalama hastalık süresi 741,06±846,84 gündü. 21 hasta yatarak tedavi almıştı. Ortalama yatış süresi 55,48±40,93 gündü. Hastaların 11’inde yüksekten düşme, 8’inde motorlu araç kazası, 6’sında ateşli silah yaralanması, 5 ‘inde sığ suya dalma, 2’sinde spinal cerrahiye bağlı olarak; 9 servikal, 17 torakal, 6 lomber düzeyde yaralanma tespit edildi. SCIWORA veya SCIWONA tespit edilen hasta yoktu. 19 inkomplet, 13 komplet yaralanma tespit edildi. En sık raporlanan komplikasyonlar; nörojenik mesane (%87,5), nörojenik barsak (%68,8) ve spastisite (%62,5) idi. Hastaların %18,8’i yatak seviyesinde, %18,8’i tekerlekli iskemle seviyesinde, %25’i terapötik ambule, %6,3’ü ev içi ambule, %31,3’ü toplum içi ambule idi.
Sonuç: Pediatrik grupta en sık olarak yüksekten düşmeye bağlı SKY geliştiği, yaralanmanın en sık olarak torakal seviyede olduğu, en sık komplikasyonların nörojenik mesane-barsak, spastisite olduğu ve hastaların büyük orada ambule olduğu saptanmıştır.
Anahtar Kelimeler
pediatrik rehabilitasyon travmatik spinal kord yaralanması komplikasyon ambulasyon
Kaynakça
- 1. Canosa-Hermida E, Mora-Boga R, Cabrera-Sarmiento J, et al. Epidemiology of traumatic spinal cord injury in childhood and adolescence in Galicia, Spain: report of the last 26-years. J Spinal Cord Med. 2019;42(4):423-9.
- 2. Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 2004;55(6):1325-43.
- 3. Pang D, Wilberger JE. Spinal cord injury without radiographic abnormalities in children. J Neurosurg. 1982;57(1):114-29.
- 4. Yucesoy K, Yuksel KZ. SCIWORA in MRI era. Clin Neurol Neurosurg. 2008;110(5):429-33.
- 5. Choi J-U, Hoffman HJ, Hendrick EB, Humphreys RP, Keith WS. Traumatic infarction of the spinal cord in children. J Neurosurg. 1986;65(5):608-10.
- 6. Hamilton MG, Myles ST. Pediatric spinal injury: review of 61 deaths. J Neurosurg. 1992;77(5):705-8.
- 7. Parent S, Mac-Thiong J-M, Roy-Beaudry M, Sosa JF, Labelle H. Spinal cord injury in the pediatric population: a systematic review of the literature. J Neurotrauma. 2011;28(8):1515-24.
- 8. Brauge D, Plas B, Vinchon M, et al. Multicenter study of 37 pediatric patients with SCIWORA or other spinal cord injury without associated bone lesion. Orthop Traumatol Surg Res. 2020;106(1):167-71.
- 9. Erhan B, Ulu MO, Gunduz B, Tanriverdi T. Pediatric spine and spinal cord injury in Istanbul: a retrospective analysis of 106 patients. Neurosurg Q. 2005;15(1):21-4.
- 10. Kim C, Vassilyadi M, Forbes JK, Moroz NW, Camacho A, Moroz PJ. Traumatic spinal injuries in children at a single level 1 pediatric trauma centre: report of a 23-year experience. Can J Surg. 2016;59(3):205.
- 11. Rush JK, Kelly DM, Astur N, et al. Associated injuries in children and adolescents with spinal trauma. J Pediatr Orthop. 2013;33(4):393-7.
- 12. Mistry D, Munjal H, Ellika S, Chaturvedi A. Pediatric spine trauma: A comprehensive review. Clin Imaging. 2022.
- 13. Dogan S, Safavi-Abbasi S, Theodore N, et al. Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases. J Neurosurg: Pediatrics. 2007;106(6):426-33.
- 14. Jarvers J-S, Herren C, Jung MK, et al. Pediatric cervical spine injuries—results of the German multicenter CHILDSPINE study. Eur Spine J. 2023:1-9.
- 15. Atesok K, Tanaka N, O’Brien A, et al. Posttraumatic spinal cord injury without radiographic abnormality. Adv Orthop. 2018;2018.
- 16. Donenberg JG, Fetters L, Johnson R. The effects of locomotor training in children with spinal cord injury: a systematic review. Dev Neurorehabil. 2019;22(4):272-87.
- 17. Vogel LC, Lubicky JP. Ambulation in children and adolescents with spinal cord injuries. J Pediatr Orthop. 1995;15(4):510-6.
- 18. Powell A, Davidson L. Pediatric spinal cord injury: a review by organ system. Phys Med Rehabil Clin N Am. 2015;26(1):109-32.
- 19. Merenda L, Park Brown J. Bladder and bowel management for the child with spinal cord dysfunction. J Spinal Cord Med. 2004;27(sup1):S16-S23.
- 20. Garcia-Arguello LY, O'Horo JC, Farrell A, et al. Infections in the spinal cord-injured population: a systematic review. Spinal Cord. 2017;55(6):526-34.
- 21. Li F, Song M, Xu L, Deng B, Zhu S, Li X. Risk factors for catheter‐associated urinary tract infection among hospitalized patients: A systematic review and meta‐analysis of observational studies. J Adv Nurs. 2019;75(3):517-27.
- 22. Mitchell BG, Prael G, Curryer C, et al. The frequency of urinary tract infections and the value of antiseptics in community-dwelling people who undertake intermittent urinary catheterization: A systematic review. Am J Infect Control. 2021;49(8):1058-65.
- 23. Vogel L, Anderson C. Spinal cord injuries in children and adolescents: a review. J Spinal Cord Med. 2003;26(3):193-203.
- 24. McCarthy J, Chafetz R, Betz R, Gaughan J. Incidence and Degree Of Hip Subluxation/Dislocation In Children With Spinal Cord Injury. J Spinal Cord Med. 2004;27(sup1):S80-S3.
- 25. Maynard FM. Immobilization hypercalcemia following spinal cord injury. Arch Phys Med Rehabil. 1986;67(1):41-4.
- 26. Jones T, Ugalde V, Franks P, Zhou H, White RH. Venous thromboembolism after spinal cord injury: incidence, time course, and associated risk factors in 16,240 adults and children. Arch Phys Med Rehabil. 2005;86(12):2240-7.
- 27. Kim J, Lee JY, Lee E. Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. J Nurs Manag. 2022;30(5):O1-O9.
- 28. Jaja BN, Jiang F, Badhiwala JH, et al. Association of pneumonia, wound infection, and sepsis with clinical outcomes after acute traumatic spinal cord injury. J Neurotrauma. 2019;36(21):3044-50.
- 29. D’Hondt F, Everaert K. Urinary tract infections in patients with spinal cord injuries. Current infectious disease reports. 2011;13(6):544-51.
- 30. Henke AM, Billington ZJ, Gater Jr DR. Autonomic dysfunction and management after spinal cord injury: a narrative review. J Pers Med. 2022;12(7):1110.
- 31. Unsal-Delialioglu S, Kaya K, Sahin-Onat S, Kulakli F, Culha C, Ozel S. Fever during rehabilitation in patients with traumatic spinal cord injury: analysis of 392 cases from a national rehabilitation hospital in Turkey. J Spinal Cord Med. 2010;33(3):243-8.
- 32. Yıldız N, Akkoç Y, Erhan B, et al. Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up. Spinal Cord. 2014;52(6):462-7.
Öz
Introduction: Traumatic spinal cord injury (SCI) is a rare entity in children. Due to anatomical and biomechanical differences in the pediatric spine, injury patterns differ from adults (1, 2).
Objective: To evaluate the sociodemographic and clinical features of pediatric patients with traumatic SCI.
Materials and Methods: The study was a retrospective descriptive study. Patients under the age of 18 with traumatic SCI were included in the study. Sociodemographic and clinical data, complications and rehabilitation outcomes were analyzed.
Results: 13 female and 19 male patients who admitted between January 2020 and August 2022 were included. The mean age was 151.96±52.81 months. The mean disease duration was 741.06±846.84 days. 21 patients were inpatient. The mean hospital stay was 55.48±40.93 days. Due to falls from height in 11, motor vehicle accidents in 8, gunshot wounds in 6, diving accident in 5, spinal surgery in 2 of the patients; 9 cervical, 17 thoracic, 6 lumbar injuries were detected. There were no SCIWORA or SCIWONA. 19 incomplete, 13 complete injuries were detected. The most frequently reported complications were neurogenic bladder (87.5%), neurogenic bowel (68.8%) and spasticity (62.5%). Of the patients, 18.8% were at bed level, 18.8% were at wheelchair level, 25% were therapeutic ambulator, 6.3% were home ambulator, and 31.3% were community ambulator.
Conclusion: In the pediatric group, it was determined that SCI developed most frequently due to falling from a height, the injury was most frequently at the thoracic level, the most common complications were neurogenic bladder-bowel, and most of the patients were ambulator.
Anahtar Kelimeler
pediatric rehabilitation traumatic spinal cord injury complication ambulation
Kaynakça
- 1. Canosa-Hermida E, Mora-Boga R, Cabrera-Sarmiento J, et al. Epidemiology of traumatic spinal cord injury in childhood and adolescence in Galicia, Spain: report of the last 26-years. J Spinal Cord Med. 2019;42(4):423-9.
- 2. Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 2004;55(6):1325-43.
- 3. Pang D, Wilberger JE. Spinal cord injury without radiographic abnormalities in children. J Neurosurg. 1982;57(1):114-29.
- 4. Yucesoy K, Yuksel KZ. SCIWORA in MRI era. Clin Neurol Neurosurg. 2008;110(5):429-33.
- 5. Choi J-U, Hoffman HJ, Hendrick EB, Humphreys RP, Keith WS. Traumatic infarction of the spinal cord in children. J Neurosurg. 1986;65(5):608-10.
- 6. Hamilton MG, Myles ST. Pediatric spinal injury: review of 61 deaths. J Neurosurg. 1992;77(5):705-8.
- 7. Parent S, Mac-Thiong J-M, Roy-Beaudry M, Sosa JF, Labelle H. Spinal cord injury in the pediatric population: a systematic review of the literature. J Neurotrauma. 2011;28(8):1515-24.
- 8. Brauge D, Plas B, Vinchon M, et al. Multicenter study of 37 pediatric patients with SCIWORA or other spinal cord injury without associated bone lesion. Orthop Traumatol Surg Res. 2020;106(1):167-71.
- 9. Erhan B, Ulu MO, Gunduz B, Tanriverdi T. Pediatric spine and spinal cord injury in Istanbul: a retrospective analysis of 106 patients. Neurosurg Q. 2005;15(1):21-4.
- 10. Kim C, Vassilyadi M, Forbes JK, Moroz NW, Camacho A, Moroz PJ. Traumatic spinal injuries in children at a single level 1 pediatric trauma centre: report of a 23-year experience. Can J Surg. 2016;59(3):205.
- 11. Rush JK, Kelly DM, Astur N, et al. Associated injuries in children and adolescents with spinal trauma. J Pediatr Orthop. 2013;33(4):393-7.
- 12. Mistry D, Munjal H, Ellika S, Chaturvedi A. Pediatric spine trauma: A comprehensive review. Clin Imaging. 2022.
- 13. Dogan S, Safavi-Abbasi S, Theodore N, et al. Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases. J Neurosurg: Pediatrics. 2007;106(6):426-33.
- 14. Jarvers J-S, Herren C, Jung MK, et al. Pediatric cervical spine injuries—results of the German multicenter CHILDSPINE study. Eur Spine J. 2023:1-9.
- 15. Atesok K, Tanaka N, O’Brien A, et al. Posttraumatic spinal cord injury without radiographic abnormality. Adv Orthop. 2018;2018.
- 16. Donenberg JG, Fetters L, Johnson R. The effects of locomotor training in children with spinal cord injury: a systematic review. Dev Neurorehabil. 2019;22(4):272-87.
- 17. Vogel LC, Lubicky JP. Ambulation in children and adolescents with spinal cord injuries. J Pediatr Orthop. 1995;15(4):510-6.
- 18. Powell A, Davidson L. Pediatric spinal cord injury: a review by organ system. Phys Med Rehabil Clin N Am. 2015;26(1):109-32.
- 19. Merenda L, Park Brown J. Bladder and bowel management for the child with spinal cord dysfunction. J Spinal Cord Med. 2004;27(sup1):S16-S23.
- 20. Garcia-Arguello LY, O'Horo JC, Farrell A, et al. Infections in the spinal cord-injured population: a systematic review. Spinal Cord. 2017;55(6):526-34.
- 21. Li F, Song M, Xu L, Deng B, Zhu S, Li X. Risk factors for catheter‐associated urinary tract infection among hospitalized patients: A systematic review and meta‐analysis of observational studies. J Adv Nurs. 2019;75(3):517-27.
- 22. Mitchell BG, Prael G, Curryer C, et al. The frequency of urinary tract infections and the value of antiseptics in community-dwelling people who undertake intermittent urinary catheterization: A systematic review. Am J Infect Control. 2021;49(8):1058-65.
- 23. Vogel L, Anderson C. Spinal cord injuries in children and adolescents: a review. J Spinal Cord Med. 2003;26(3):193-203.
- 24. McCarthy J, Chafetz R, Betz R, Gaughan J. Incidence and Degree Of Hip Subluxation/Dislocation In Children With Spinal Cord Injury. J Spinal Cord Med. 2004;27(sup1):S80-S3.
- 25. Maynard FM. Immobilization hypercalcemia following spinal cord injury. Arch Phys Med Rehabil. 1986;67(1):41-4.
- 26. Jones T, Ugalde V, Franks P, Zhou H, White RH. Venous thromboembolism after spinal cord injury: incidence, time course, and associated risk factors in 16,240 adults and children. Arch Phys Med Rehabil. 2005;86(12):2240-7.
- 27. Kim J, Lee JY, Lee E. Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. J Nurs Manag. 2022;30(5):O1-O9.
- 28. Jaja BN, Jiang F, Badhiwala JH, et al. Association of pneumonia, wound infection, and sepsis with clinical outcomes after acute traumatic spinal cord injury. J Neurotrauma. 2019;36(21):3044-50.
- 29. D’Hondt F, Everaert K. Urinary tract infections in patients with spinal cord injuries. Current infectious disease reports. 2011;13(6):544-51.
- 30. Henke AM, Billington ZJ, Gater Jr DR. Autonomic dysfunction and management after spinal cord injury: a narrative review. J Pers Med. 2022;12(7):1110.
- 31. Unsal-Delialioglu S, Kaya K, Sahin-Onat S, Kulakli F, Culha C, Ozel S. Fever during rehabilitation in patients with traumatic spinal cord injury: analysis of 392 cases from a national rehabilitation hospital in Turkey. J Spinal Cord Med. 2010;33(3):243-8.
- 32. Yıldız N, Akkoç Y, Erhan B, et al. Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up. Spinal Cord. 2014;52(6):462-7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 18 Aralık 2023 |
| Gönderilme Tarihi | 22 Aralık 2022 |
| Yayımlandığı Sayı | Yıl 2023Cilt: 62 Sayı: 4 |
