Search Results (19)

Lipomyelomeningocele (LMMC) is one of the most common forms of occult spinal dysraphism, with an estimated incidence of 3–6 per 100,000 live births, and microsurgical untethering remains the cornerstone of management for symptomatic and selected at-risk children. The operation is technically demanding: reported rates of long-term symptomatic re-tethering after partial resection still reach 15–25%, and the surgeon must balance adequate untethering against preservation of the placode and lumbosacral nerve roots. In this technical note, we present a stepwise, illustrated description of our institutional 14-step microsurgical technique for pediatric LMMC. Each step is anchored to a defined anatomical landmark, beginning with a midline skin incision planned away from the anal verge and proceeding through subtotal subcutaneous lipoma resection, identification of the dural penetration site, a limited rostral laminectomy over normal anatomy, dural opening with circumferential dissection of lipoma–dura–cord adhesions, exploitation of the arachnoid–dura plane, electrophysiologically guided debulking of the intradural lipoma, stimulation-controlled division of the fatty filum, pia-to-pia reconstruction of the placode with 8-0 monofilament suture, expansile duraplasty with an artificial dural substitute, and reinforced multilayered watertight closure. Technical pearls aimed at minimizing the risks of cord injury, cerebrospinal fluid leak, and postoperative re-tethering are highlighted at each stage, and the role of multimodal intraoperative neurophysiological monitoring is emphasized. This note is intended as a practical, image-anchored operative reference for pediatric neurosurgeons and trainees managing this challenging closed neural tube defect. Full article

Background/Objectives: Pediatric spinal cord injury (SCI) is a rare yet highly disabling condition associated with substantial functional and psychosocial impairments. Although robot-assisted gait training (RAGT) and transcutaneous spinal cord stimulation (tSCS) have independently demonstrated promising results, evidence regarding their combined use in pediatric SCI is limited. This study aimed primarily to assess the feasibility and safety of combining RAGT with tSCS in children with incomplete SCI, and secondarily to explore its effects on clinical outcomes. Methods: A case series study was conducted that included three pediatric participants (<18 years) with chronic incomplete SCI (AIS C–D). Participants completed five consecutive sessions of RAGT using a Lokomat device combined with tSCS applied at the lumbosacral level. Each session consisted of 30 min of gait training, including 20 min of concurrent electrical stimulation. Safety was assessed through adverse-event monitoring and pain evaluation. Clinical outcomes included gait speed (10MWT), trunk control (SATCo), lower-limb strength (LEMS), and spasticity (MAS). Results: Session adherence reached 100%. Skin erythema was the most frequently reported adverse event and showed a clear association with tSCS. All participants demonstrated improvements in gait speed, with two exceeding the minimal clinically important difference. Secondary results showed similar outcomes for spasticity, strength, and trunk control, with no clinically meaningful changes in any case. Conclusions: The combined application of RAGT and tSCS appears to be a feasible and safe intervention for children with incomplete SCI. Preliminary findings suggest potential benefits in gait speed, thereby supporting the need for further investigation with larger samples and controlled study designs. Full article

Background/Objectives: Sexual dysfunction (SD) and broader sexual health problems are common after neurological disorders, yet interventional evidence is fragmented across conditions and outcomes. This umbrella review mapped and appraised systematic review-level evidence on interventions targeting SD and sexual health in neurological populations and qualified conclusions using certainty of evidence. Methods: PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, EBSCOhost, and Scopus were searched from inception to 27 November 2025. Two reviewers screened records, extracted data, assessed review quality with AMSTAR 2, and rated certainty across intervention–outcome pairings using a GRADE-informed approach that integrated review confidence and primary-study risk-of-bias as reported by the source reviews. Results: Twenty-six systematic reviews were included. Overall confidence was frequently limited (17/26 critically low and 6/26 low), with only a small subset rated moderate or higher. Evidence was most coherent for phosphodiesterase type 5 (PDE5) inhibitors improving erectile function in men with spinal cord injury, whereas most other interventions and outcomes were supported by low or very low certainty. Women were represented in 16/26 reviews, yet validated female sexual function outcomes were synthesized in 6/26 reviews and relationship/couple outcomes in 3/26; furthermore, 10/26 reviews restricted inclusion to men, and no review synthesized pediatric intervention trials. Conclusions: Evidence supports PDE5 inhibitors for improving erectile function in men with spinal cord injury, while evidence for other interventions and sexual health domains remains limited. Methodological limitations highlight the need for more inclusive trials, broader standardized outcomes, and longer follow-up within neurorehabilitation pathways. Full article

Objectives: Among the spectrum of spinal injuries, Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) occupies a unique and challenging position. SCIWORA presents diagnostic and therapeutic challenges due to its broad clinical and radiological heterogeneity. While most children recover favorably with conservative treatment, a subset may require surgery based on imaging findings. The findings underscore the need for standardized diagnostic criteria, MRI-based classification systems, and evidence-based treatment algorithms to improve consistency in care and long-term neurological outcomes. Methods: A systematic search of PubMed, Cochrane, Scopus, and Embase databases was performed through June 2025 following PRISMA guidelines. Inclusion criteria encompassed studies of pediatric SCIWORA (age < 18 years) reporting demographics, clinical and radiological features, management, and outcomes. Results: Sixty studies encompassing a total of 848 pediatric patients were included. The mean patient age was 9.33 years (±2.52), with a slight male predominance. The most common trauma mechanisms were road traffic accidents (40.3%), sports injuries (22%), and falls (18.8%). MRI findings were available in 399 cases: 46% had intraneural lesions (Type IIb), 39% showed no abnormality on MRI (Type I, or “real SCIWORA”), 9% had combined lesions (Type IIc), and 6% had extraneural abnormalities (Type IIa). Neurological severity at presentation was primarily ASIA Grade A (46.25%), but follow-up data showed substantial improvement, with ASIA E (normal function) increasing to 49.78%. Overall, 66.2% of patients experienced neurological improvement, while 33.8% remained stable. Conservative treatment was employed in 95.41% of cases. Only 4.59% underwent surgery, which was typically reserved for MRI-positive lesions demonstrating spinal instability or compression. Conclusions: Pediatric SCIWORA remains an uncommon but potentially devastating injury, with an outcome highly dependent on MRI findings and initial neurological status. This systematic review aims to clarify the contemporary understanding of pediatric SCIWORA, delineating “real” SCIWORA from other SCIWORA-like entities, and synthesizing the latest evidence regarding epidemiology, mechanisms, clinical presentation, MRI findings, and management in children. Full article

Background/Objectives: Non-invasive spinal cord transcutaneous stimulation (scTS) has expanded the therapeutic landscape of spinal cord injury (SCI) rehabilitation, offering potential benefits beyond compensatory approaches to paralysis. Children with SCI are particularly susceptible to developing neuromuscular scoliosis due to trunk muscle paralysis and ongoing skeletal growth, making targeted interventions crucial. As demonstrated in adults and pediatrics with SCI, the ability of scTS to acutely and safely enable an upright posture and trunk control could be leveraged as a therapeutic adjunct. Activity-based locomotor training (AB-LT) alone significantly improves trunk control in children with SCIs; combining it with scTS may enhance outcomes. This pilot study evaluated the safety, feasibility, and cumulative effects of AB-LT combined with scTS on trunk control in children with SCI. Methods: Three children with SCI completed 19 to 64 sessions of combined AB-LT and scTS. Adverse effects were monitored session to session, and trunk control was assessed pre- and post-intervention. Results: Across 130 interventions in three participants, 88.5% of sessions were free from adverse effects. Reported adverse events included autonomic dysreflexia (5.4%), skin redness at electrode sites (4.6%), and headaches (1.5%). No significant impact of scTS on fatigue or central hemodynamic parameters was observed. Post-intervention, all participants demonstrated improved trunk control during quiet and perturbed sitting. Conclusions: These findings provide the first evidence supporting the safety and feasibility of this combinatorial approach in pediatric SCI rehabilitation while emphasizing the importance of monitoring skin integrity and signs of autonomic dysreflexia. This intervention shows potential synergistic benefits, warranting further research to confirm efficacy and optimize therapeutic protocols. Full article

Background/Objectives: Surgery for adolescent idiopathic deformities is often aimed at improving aesthetic appearance, striving for the best possible correction. However, severe and rigid scoliotic curves not only present aesthetic issues but can also compromise cardiopulmonary health and cause early neurological impairment due to spinal cord compression, posing significant risks of morbidity and mortality if untreated. Conservative treatments are ineffective for severe curves, defined by scoliotic angles over 70° and flexibility below 30% on lateral bending X-rays. Treatment often requires invasive interventions, such as osteotomies and vertebral resections. In particular, posterior vertebral column resection (PVCR) has shown effectiveness in realigning vertebral structures in complex cases. This study describes the efficacy and risks of PVCR through a series of cases treated at our institution. Methods: This case series was conducted at the Rizzoli Orthopedic Institute in Bologna, involving eight pediatric patients with severe, rigid spinal deformities, operated upon between 2018 and 2023. The underlying pathologies included idiopathic kyphoscoliosis, neurofibromatosis type 1, Pott’s disease, and other congenital anomalies. Preoperative assessment included standard radiographs, magnetic resonance imaging, and computed tomography. During PVCR, motor and sensory evoked potentials were monitored to minimize neurological injury risk. Postoperative management included blood transfusions, antibiotic support, and early physiotherapy. Results: PVCR resulted in an average reduction in the Cobb angle from 86.3° preoperatively to 22.4° postoperatively, with a mean correction of 64%. The mean duration of the procedures was 337.4 min. Three patients had an uneventful postoperative course, while five developed complications, including infections and temporary neurological deficits, which were successfully managed. One patient developed an epidural hemorrhage that required emergency surgery for hematoma evacuation, with partial recovery. This study demonstrates the potential of PVCR for correcting rigid spinal deformities, highlighting the importance of postoperative management to minimize the associated risks. Conclusions: Posterior vertebral resection techniques offer significant promise in the correction of pediatric spinal deformities. Although ours is a small case series, it can provide important data for such treatment. Long-term monitoring is needed to fully understand the impact of these procedures and to further refine surgical techniques. Full article

Background/Objectives: Overall priorities of the international pediatric-onset spinal cord injury (SCI) population are unknown. The purpose was to describe and compare Life and Health (L&H) domain overall priorities of European youth with SCI and their parents and caregivers (P&C). Methods: A survey with a cross-sectional design, prepared by the PEPSCI Collaboration, was conducted in six European countries. In total, 202 participants, including youth with SCI (n = 101) and their P&C (n = 101), were included. Overall priorities were calculated based on unhappiness, importance, and research. Results: The sample included youth aged 8–12 years (30.7%) and 13–25 years (69.3%; 38.6% 13–17-year-olds and 30.7% youth aged 18–25 years), in addition to their P&C. The top three L&H priorities highlighted by P&C of the youth aged 8–12 years were “bladder” function (78%), “leg/foot movement” (77%), or “bowel” function (74%), compared with “leg/foot movement” (79%), “sit-to-stand” (76%), or “walking/ability to move” (75%) reported by P&C of the youth aged 13–25 years. The youth aged 13–25 years considered “leg/foot movement” (68%), “bowel” (66%), or “bladder” function (65%) as priorities. The top 10 priorities highlighted by the youth aged 13–25 years compared to the top 10 priorities rated by P&C were issues related to “personal needs”. Nevertheless, “pressure injuries”, “pain”, “bowel function”, or “mobility in the community” were highlighted as top preferences of priorities for the youth aged 13–25 years compared to their P&C. Conclusions: Adolescents/young adults highlighted health domain priorities compared with their P&C, who equally considered L&H domains. Life domains, which were previously unaddressed, were highlighted by P&C, including “adulthood expectations” and “parenthood expectations”. This survey will promote the involvement of stakeholders for comprehensive rehabilitation management for this population. Full article

Objective: To evaluate neurogenic bladder and bowel dysfunction (NBBD) in children with cerebral palsy (CP) and acquired brain injury (ABI), a condition considered less frequent in those patients than in children with spinal cord injury (SCI), and to study the relationship between NBBD and disability grade in this population. Study Design: We retrospectively reviewed the clinical data of all patients (aged 3–18 years old) admitted during a three-month observation in our neurorehabilitation department. Data collected were as follows: demographic parameters; disability status (Wee-FIM Scale, Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System); and gastrointestinal and urological symptoms (diaries, Bristol scale, Pad Test and International Consultation on Incontinence Modular Questionnaire). Results: Sixty patients were enrolled (31 females, 29 males): 30 CP, 17 ABI, 3 SCI, and 10 others with neurological diseases. All presented urinary incontinence without gender differences. CP and ABI had major incidences of bowel dysfunction (50% and 64.7%, respectively) and SCI of urinary tract infections (66.6%) and enuresis (100%). A major incidence of symptoms was recorded in patients with higher GMFCS levels (level 3-4-5). Conclusions: NBBD has a high frequency in children with CP and ABI, as in SCI. More attention is needed from pediatricians and pediatric urologists for this clinical entity. Further studies are needed to better understand clinical relevance and, therefore, to establish specific management. Full article

Background: Limited research exists for use of transcutaneous spinal stimulation (TSS) in pediatric spinal cord injuries (SCI) to improve walking outcomes, especially in children diagnosed with SCI secondary to acute flaccid myelitis (AFM). Objective: This case series demonstrates the feasibility and efficacy of TSS paired with gait training in children diagnosed with AFM. Methods: A total of 4 participants diagnosed with incomplete SCI secondary to AFM completed 22, 2-h therapy sessions over 5–8 weeks. TSS paired with body weight-supported treadmill training (BWSTT) was provided for the first 30 min of each session. Changes in walking function were assessed through the 6 min walk test (6MWT), Timed Up and Go (TUG), 10 m walk test (10MWT), and walking index for spinal cord injury II (WISCI-II). To assess safety and feasibility, pain, adverse events, and participant and therapist exertion were monitored. Results: All participants tolerated the TSS intervention without pain or an adverse response. Changes in the 6MWT exceeded the minimal clinically important difference (MCID) for three participants and WISCI-II exceeding the minimal detectable change (MDC) for two of the participants. Conclusions: These results demonstrate that TSS is a safe and clinically feasible intervention for pediatric patients with AFM and may supplement gait-based interventions to facilitate improvements in walking function. Full article

A spinal cord injury (SCI) can be a devastating condition in children, with profound implications for their overall health and quality of life. In this review, we aim to provide a concise overview of the key aspects associated with SCIs in the pediatric population. Firstly, we discuss the etiology and epidemiology of SCIs in children, highlighting the diverse range of causes. We explore the unique anatomical and physiological characteristics of the developing spinal cord that contribute to the specific challenges faced by pediatric patients. Next, we delve into the clinical presentation and diagnostic methods, emphasizing the importance of prompt and accurate diagnosis to facilitate appropriate interventions. Furthermore, we approach the multidisciplinary management of pediatric SCIs, encompassing acute medical care, surgical interventions, and ongoing supportive therapies. Finally, we explore emerging research as well as innovative therapies in the field, and we emphasize the need for continued advancements in understanding and treating SCIs in children to improve their functional independence and overall quality of life. Full article

Muscle loss is consistently associated with immobility and paralysis and triggers significant metabolic and functional changes. The negative effects of sarcopenia are amplified in children who are in the process of building their muscle mass as part of development. Because muscle mass loss is consistently associated with increased morbidity and mortality throughout life, optimizing the size and health of muscles following a neurologic injury is an objective target for therapeutic interventions. This review hypothesizes that muscle mass correlates with functional outcomes in children with paralysis related to spinal cord-related neurologic deficits. We propose that the measurement of muscle mass in this population can be used as an objective outcome for clinical long-term care. Finally, some practical clinical approaches to improving muscle mass are presented. Full article

The upper extremity behavior in smoothness and efficiency metrics should be different between paraplegic and tetraplegic patients. The aim of this article was to analyze the behavior of these metrics after receiving upper extremity training with the humanoid robot Robic as a treatment. Ten pediatric patients participated in the study and completed ten experimental sessions with Robic. Patients were assessed at baseline and at ending the training using the Box and Block test and a non-immersive virtual application based on the Leap Motion Controller available in the RehabHand software. From this application, the smoothness metric was calculated as the number of peaks or units of movement detected in the velocity profile of the hand during the execution of the task, and the efficiency metric was assessed by calculating the length of the hand trajectory. Patients with tetraplegia had a significantly longer trajectory (286.01 ± 59.87 mm) than paraplegics (123.61 ± 17.14 mm) in the baseline situation. However, at the end of the training, there were no differences between them. In the Box and Block test, the paraplegic group passed more cubes than tetraplegics. In conclusion, the first experience with a Robic robot in SCI was very positive, with observed improvements in upper extremity dexterity in trained patients. Full article

Incomplete spinal cord injuries (ISCI) in pediatrics and adults can lead to asymmetric motor impairments exhibiting as asymmetries of posture and gait. Recently, rehabilitation guidelines for adults with neurologic injuries have focused on gaining a functional gait pattern as measured by speed and distance, even if asymmetry deficits persist. Activity-based restorative therapies (ABRT) take advantage of activity-dependent neuroplasticity to change an individual’s neuromuscular capacity. This is a report of an ambulatory child with chronic ISCI presenting with significant postural and gait asymmetries who enrolled in an ABRT program. Across 79 ABRT sessions, the child gained symmetry during sitting, standing, and walking. Even though this child was a functional ambulator at enrollment, targeting symmetry of movements via improved neuromuscular capacity further enhanced her achievement of kinematically appropriate function for participation in daily activities. Full article

Pediatric spina bifida (SB) and spinal cord injury (SCI) are unfortunately common in our society, and their unique findings and comorbidities warrant special consideration. This manuscript will discuss the epidemiology, pathophysiology, prevention, and management strategies for children growing and developing with these unique neuromuscular disorders. Growth and development of the maturing child places them at high risk of spinal cord tethering, syringomyelia, ascending paralysis, pressure injuries, and orthopedic abnormalities that must be addressed frequently and judiciously. Similarly, proper neurogenic bladder and neurogenic bowel management is essential not just for medical safety, but also for optimal psychosocial integration into the child’s expanding social circle. Full article

The aim of this study was to describe the needs and research priorities of Swiss children/adolescents and young adults (from here, “young people”) with spinal cord injury/disorder (SCI/D) or spina bifida (SB) and their parents in the health and life domains as part of the international Pan-European Pediatric Spinal Cord Injury (PEPSCI) collaboration. Surveys included queries about the satisfaction, importance, research priorities, quality of life (QoL), and characteristics of the young people. Fifty-three surveys with corresponding parent-proxy reports were collected between April and November 2019. The self-report QoL sum scores from young people with SCI/D and SB were 77% and 73%, respectively. Parent-proxy report QoL sum scores were lower, with 70% scores for parents of young people with SCI/D and 64% scores for parents of young people with SB. “Having fun”, “relation to family members”, and “physical functioning” were found to be highly important for all young people. “Physical functioning”, “prevention of pressure injuries”, “general health”, and “bowel management” received the highest scores for research priority in at least one of the subgroups. As parents tend to underestimate the QoL of their children and young people prioritized research topics differently, both young peoples’ and caregivers’ perspectives should be included in the selection of research topics. Full article