Spinal Cord Injury and Iatrogenic Lesions
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Giulio Del Popolo and Elena Tur
14.1 Introduction Traumatic spinal cord injury is a dramatic event in the lives of men and women; it changes the motor and functional control of the body. The impact of an acquired spinal cord lesion in children and adolescents, during a delicate phase of their physiological body development, is a hard issue to manage. This represents a lifelong change for patients and their family life. Few centers in the world are dedicated to the management of this condition in pediatric patients, to address their needs and continue follow-up with the patient and family through to adulthood. Then transitional care is necessary to guarantee continuous treatment without fragmentation that could pose risks of psychological and physical complications, which need to be prevented because they are not easy to resolve.
14.2 Epidemiology Spinal cord injury (SCI) is a traumatic condition, which can lead to sensory and motor disorganization of the normal physiology of internal organs and systems, and really changes mental and psychological issues, and social well-being as well. In children, SCI is less common than in adults and occurs in approximately 1.5–5% of cases [1, 2]. Statistical data and reviews show that the incidence of SCI increases with age [3]. The level of injury differs depending on the age category, with C2 vertebral lesions tending to occur in preteens, C4 lesions tending to occur in teenagers, and C4–C5 lesions tending to occur in adults [2]. In one series, violent etiologies (especially gunshot wounds) accounted for a significant proportion of preteen injuries (19% versus 12% in adults) [3].
G. Del Popolo (*) • E. Tur Neuro-Urology and Spinal Unit, Careggi University Hospital, Florence, Italy © Springer International Publishing AG, part of Springer Nature 2018 G. Mosiello et al. (eds.), Clinical Urodynamics in Childhood and Adolescence, Urodynamics, Neurourology and Pelvic Floor Dysfunctions, https://doi.org/10.1007/978-3-319-42193-3_14
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G. Del Popolo and E. Tur Detrusor Overactive
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Urethral sphincter Lesion: Spinal
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Fig. 14.1 (Source: adapted from EAU Guidelines 2015) Madersbacher classification urodynamic patterns in neuro-urological patients
There are two main mechanisms of SCI injury in pediatric patients. The motor vehicle accident mechanism is more common in young children, while in adolescents the most common mechanism is a sports injury [4]. Most studies report a large predominance of males in comparison with females [2, 4–9]. It is believed that neurological rehabilitation occurs faster in pediatric patients than in adults [9]; however, there are no accurate data to support this belief [3]. In both children and adults after SCI, bladder contr
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