While some pediatric spinal-column injuries may be managed by external bracing alone, ligamentous injuries generally predispose to long-term instability and risk of secondary complications or spinal-cord injury. For these patients, fusion must be considered. However, from a technical standpoint, fusion may be difficult to achieve in infants and very young children. Fortunately, the latter patients also have a greater ability to spontaneously recover stability after ligamentous injury. Surgical intervention for spinal-column and cord injury in children has three goals:
1. Decompression of the spinal-cord parenchyma to prevent secondary injury. The timing of decompressive surgery is controversial, with some evidence suggesting greater benefit to neurological prognosis with immediate surgery, but other data suggesting a higher risk of neurological or systemic complications after early surgery.
2. Spinal-column stabilization. An unstable spinal column may contribute to progressive spinal deformity, chronic pain, functional limitations and secondary spinal-cord injury from compression.
3. Early mobilization and participation in rehabilitation. Functional outcomes are enhanced, and medical complications such as pneumonia, uro-sepsis and pulmonary embolism are reduced by early participation in rehabilitation after spine stabilization.
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