Spinal cord injury (sci) before the age of 15 years is a relatively rare occurrence, but it can have important psychological and physiological consequences. Although the exact frequency is unknown, it represents <4% of the overall incidence of SCI annually (National Spinal Cord Injury Statistical Center, 2004). The mechanism of injury, the male:female ratio, and the level of injury are different than in the adult population. The incidence increases rapidly with age, with >30% of injuries occurring between the ages of 17 and 23, and 53% occurring between the ages of 16 and 30. The rate of recovery following SCI in the pediatric population is also thought to be faster.

This systematic review of the literature was undertaken to evaluate three specific questions: 1) What is the epidemiology of pediatric SCI and fractures; 2) Are there unique features of pediatric SCI that distinguish the pediatric SCI population from the adult SCI population; and 3) Is there evidence to support the use of neuroprotective approaches, including hypothermia and steroids, in the treatment of pediatric SCI. The systematic review approach was chosen to review the evidence surrounding these aspects of pediatric SCI because of the paucity (or nonexistence) of good randomized controlled trials for this particular problem.