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Epidemiology of Pediatric SCI

Sports/Leisure

With some pediatric-aged individuals being heavily involved in sports and other extracurricular activities, it is not surprising that sports and leisure activities contribute to SCI in the pediatric population. SCI due to sports and leisure activities can be caused by accidents in all sports, such as diving injuries, football injuries, bicycle crashes, all-terrain vehicle incidents (ATVs), and activities involving trampolines (Babcock et al. 2018; Canosa-Hermida et al. 2019; Hwang et al. 2003). ATV-related incidents can lead to serious injuries, sometimes causing SCI resulting in paraplegia and quadriplegia (Mangano et al. 2006; Sneed et al. 1986). An important contributor to ATV injuries is the lack of helmet use. In fact, the majority of individuals suffering injury via ATV crashes were not wearing a protective helmet (Carr et al. 2004). Although rare, sledding is another leisure activity that can lead to life-altering SCI and vertebral fracture (Noffsinger et al. 2008).

Like football, rugby, and other contact sports, hockey is a game in which intentional contact with other players can cause injury (Brown et al. 2001). In some unusual instances, hockey contact has led to the ligamentous injury of the cervical spine, causing tetraplegia in children.  When it comes to hockey, injuries to the spine have shown to be most common in younger children (≤14 years old) (Polites et al. 2014). The trampoline is another apparatus that has produced significant injuries in the pediatric population. Spinal injuries associated with the trampoline generally lead to cervical and thoracic fractures, and more infrequently, paraplegia. SCI is most commonly associated with jumping on the trampoline and landing improperly (i.e., jumping into a foam pit or the hitting head, as opposed to falling off the trampoline) (Furnival et al. 1999; Kasmire et al. 2016).

In general, as it relates to sports and recreational activities, research has found that children with this type of trauma have increased odds of cervical spine injury if they had focal neurologic findings, had complaints of neck pain, was injured diving, or sustained axial loading impacts (Babcock et al. 2018). Sports and leisure-related SCI has been seen in individuals ages 0 – 18 years; however, it is most common in teenagers (Baker et al. 1999; Canosa-Hermida et al. 2019; Cirak et al. 2004; DeVivo & Vogel 2004; Finch & Barnes 1998; Sneed et al. 1986). Findings have also indicated that SCI is much more likely to be neurologically complete in younger persons (DeVivo & Vogel 2004). Insults caused by sports can also lead to contiguous and noncontiguous multilevel SCI in children (Mortazavi et al. 2011). Moreover, as in the instance of other traumatic SCI etiology like transport and falls, some instances of SCI due to sports/leisure accidents saw spinal cord without radiological abnormality (SCIWORA) (Carroll et al. 2015).

Research has found that the mechanism of the neural injury likely relates to the inherent elasticity of the adolescent spine, which allows self-reducing yet significant intersegmental displacements when subjected to flexion, extension, and distraction forces.  This makes the spinal cord vulnerable to injury even though the vertebral column is spared from disruption. This vulnerability is most evident in children younger than 8 years of age (Pang & Pollack 1989). In fact, pediatric SCI is a very distinct injury profile, as anatomical and biomechanical features distinguish the younger immature spine from older adolescents with a more mature, adult-like spine. This means that while less likely to experience SCI, younger children have a higher incidence of neurological injury and a higher frequency of SCIWORA and upper cervical spine injury (Hamilton & Myles 1992). Examples of this phenomenon can be seen in individuals doing the back bend motion during dance class, causing pediatric thoracic SCIWORA (Ren et al. 2017). Based on the above information, it appears that SCI in sports and leisure activities is predominantly the result of impact from contact with other individuals or surfaces. Knowing this, precautions can be taken to protect the pediatric population from severe injuries in the future.

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