The classification of consequences and complications of spinal cord injury in children

BACKGROUND: Consequences and complications of spinal cord injury in children which appear at all recovery stages significantly affect outcomes. The Classification proposed in 1994 does not provide a clear distinction between terms "consequences" and "complications" and currently, in our opinion, is outdated and was outdated long ago, since it raises more questions than it contains answers. AIM: to propose a new classification of spinal cord injury consequences and complications in children covering all periods of the injury course. MATERIAL AND METHODS: Children with severe spinal and spinal cord injury who have been admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in Moscow since 2014 were taken into the study. To diagnose their current state, the following diagnostic tools were used: clinical examination, trophological status, neurological assessment by ASIA scale, locomotor pattern, laboratory and instrumental testings; in addition, psychological examination so as to identify child's post-traumatic disadaptation and psychopathological state. RESULTS: Three years after the injury, spinal cord injury consequences were detected in 96% of injured children; spinal cord injury complications― in 56% of children who were treated at Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in 20142020. The authors have developed a new classification of spinal cord injury consequences and complications in children. CONCLUSION: The early start of rehabilitation measures and subsequent long-term medical and psychological support of children with spinal cord injury delays the onset of spinal cord injury consequences, prevents complications, as well as encourages the child and his/her parents to comply with the recommendations of the rehabilitation team. Underestimation of the severity of child's condition can lead not only to the deprivation of motor restoration, but also to the deterioration in the quality of family life and to the problem of integrating children with spinal cord injury into the society. The newly developed classification is an important instrument to improve injury outcomes, child's growth and development as well his/her integration into the social environment.