Department of Research and Innovation, Institut Guttmann - Hospital de Neurorehabilitació, Institut Universitari de Neurorehabilitació adscrit a la UAB, Cami Can Ruti s/n, 08916, Badalona, Barcelona, Spain.
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
Eur Spine J. 2024 Dec;33(12):4437-4448. doi: 10.1007/s00586-024-08351-1. Epub 2024 Jun 9.
Existing literature on pediatric traumatic spinal cord injury (PTSCI) demonstrates large variations in characteristics, incidence, time-periods and etiology, worldwide. Epidemiological studies addressing injuries to the total spine, conducted in Southern European regions are remarkably scarce; therefore we aimed to investigate long-term trends analyzing etiology, fracture location and type, single or multiple fractures, associated lesions and neurological status in Catalonia, Spain.
We conducted a retrospective observational study. We analyzed post-acute patients after PTSCI, aged 0-17, admitted with neurological deficits between 1986 and 2022 to a specialized hospital in Catalonia. Neurological deficits were assessed using the American Spinal Injury Association Impairment Scale (AIS).
Two hundred and forty nine children were included, 174 (69.9%) boys and 75 (30.1%) girls; mean age was 13.9 years (range, 2 months to 17 years). Two hundred and four children (82%) had ≥ 1 spinal fractures, 66 (26.5%) dislocations and 8 (3.2%) SCIWORA. Fractures were multilevel contiguous in 108 (43.4%) cases. Fracture types comprised 81 vertebral compactions (32.5%), 22 burst fractures (8.8%), 7 odontoid (2.8%) and 4 tear-drops (1.6%). There were ≥ 1 associated lesions in 112 cases (45%): in limbs in 23 cases (9.2%), thorax or abdomen in 59 (23.7%) and skull or face in 81 (32.5%). In 44 cases (39% of the 112) there were multiple lesions. Locations comprised cervical spine in 105 cases (42%), thoracic spine in 124 (49%), lumbar spine in 18 (7%), and sacrum in 2 (0.8%). Road traffic accidents (RTAs) were the main etiology (62.2%) over the whole period. However, from 2016 onwards, RTAs dropped below the rate of falls and sports injuries. The most common sites for injury in those aged 9 years or older were in the cervical (41.1%) and thoracic (50.7%) regions. Those aged 8 or under were far more likely to sustain a complete SCI (80.0%) or an accompanying traumatic brain injury (45.0%) likely due to higher numbers of pedestrian versus car RTAs. A significant peak in the occurrence of cases during 2006-2010 (20.1%) was identified with an absolute drop immediately after, during 2011-2015 (8.8%). A marked shift in trend is observed between 2016-2022 regarding age of injuries (an increase in 9 years or older), etiology (increase in falls and sports versus RTA), AIS grade (increase in incomplete lesions AIS B-D versus AIS A), severity (increase in tetraplegia versus paraplegia) and location (increase in cervical versus lumbar and thoracic injuries).
A shift in trend is observed in the past 7 years regarding age of injuries (increase in those older than 9), etiology (increase in falls and sports versus RTA), AIS grade (increase in incomplete lesions AIS B-D versus AIS A), severity (increase in tetraplegia versus paraplegia) and location (increase in cervical).
IV.
现有的儿科创伤性脊髓损伤 (PTSCI) 文献表明，全球范围内，其特征、发病率、时间段和病因存在很大差异。在南欧地区进行的涉及整个脊柱损伤的流行病学研究非常罕见；因此，我们旨在研究长期趋势，分析病因、骨折部位和类型、单发或多发骨折、相关损伤和西班牙加泰罗尼亚的神经状态。
我们进行了一项回顾性观察性研究。我们分析了在加泰罗尼亚一家专门医院就诊的患有 PTSCI 的急性后患儿，年龄在 0-17 岁之间，存在神经功能缺损，时间在 1986 年至 2022 年之间。使用美国脊髓损伤协会损伤量表（AIS）评估神经功能缺损。
共纳入 249 名儿童，其中男 174 名（69.9%），女 75 名（30.1%）；平均年龄为 13.9 岁（范围 2 个月至 17 岁）。204 名儿童（82%）有≥1 个脊柱骨折，66 名（26.5%）有脱位，8 名（3.2%）有 SCIWORA。108 例（43.4%）骨折为多节段连续骨折。骨折类型包括 81 例椎体压缩性骨折（32.5%）、22 例爆裂性骨折（8.8%）、7 例寰椎骨折（2.8%）和 4 例泪滴样骨折（1.6%）。112 例（45%）有≥1 处相关损伤：23 例（9.2%）在四肢，59 例（23.7%）在胸或腹部，81 例（32.5%）在颅骨或面部。44 例（39%的 112 例）有多处损伤。骨折部位包括颈椎 105 例（42%）、胸椎 124 例（49%）、腰椎 18 例（7%）和骶骨 2 例（0.8%）。道路交通意外（RTAs）是整个时期的主要病因（62.2%）。然而，自 2016 年以来，RTAs 的发生率低于跌倒和运动损伤。9 岁及以上儿童最常见的损伤部位是颈椎（41.1%）和胸椎（50.7%）。8 岁及以下儿童更有可能发生完全性脊髓损伤（80.0%）或伴有外伤性脑损伤（45.0%），可能是由于行人与汽车 RTAs 的比例较高。2006-2010 年期间，病例发生数量出现了一个显著的高峰（20.1%），之后在 2011-2015 年立即出现了一个明显的下降（8.8%）。2016-2022 年期间，在受伤年龄（9 岁以上儿童比例增加）、病因（跌倒和运动受伤比例增加，RTAs 比例减少）、AIS 分级（不完全损伤 AIS B-D 比例增加，AIS A 比例减少）、严重程度（四肢瘫痪比例增加，截瘫比例减少）和部位（颈椎损伤比例增加，腰椎和胸椎损伤比例减少）方面观察到明显的趋势变化。
在过去 7 年中，受伤年龄（9 岁以上儿童比例增加）、病因（跌倒和运动受伤比例增加，RTAs 比例减少）、AIS 分级（不完全损伤 AIS B-D 比例增加，AIS A 比例减少）、严重程度（四肢瘫痪比例增加，截瘫比例减少）和部位（颈椎损伤比例增加）方面出现了趋势变化。
IV。
