Non-traumatic slow spinal cord compression (SCC) is defined as a pathological process that, through mechanical and/or vascular phenomena, leads to a progressive loss of spinal cord function in the absence of trauma [1] [2] . In children, it remains a rare [3] [4] and under-evaluated pathology. Etiologies vary depending on the region. Treatment is mainly surgical. The prognosis is essentially functional and depends on early diagnosis and medical-surgical treatment. However, when discovered late, SCC in children presents neurological complications that are sometimes irreversible and sometimes fatal. In sub-Saharan Africa, few studies are devoted to it [3] . The scarcity of scientific work is an argument that motivated us to conduct this study.

This is a retrospective study of 57 children under 18 years of age collected at the neurosurgery department of the National University Hospital (CHNU) of FANN, from January 1, 2010, to December 1, 2022. All were included in our study. Children presenting clinical signs of spinal cord compression as well as signs of radiological compression. The etiological diagnosis was made on the basis of biological examinations and samples taken in the operating room. All children benefited from a follow-up of at least twelve months. In this study, we describe the epidemiological factors, including age and sex, clinical presentation with Frankel classification, imaging to identify the site of injury by spine CT and MRI, injury management including surgery, indication, time before surgery, associated therapies such as physiotherapy, etiologies and deficit in recovery progression. Data collection was performed on medical records using a survey form.

During this study, the annual frequency was 4.38 cases. Pediatric CML accounted for 9.1% of all CML treated during our study period. The mean age was 9 years. Adolescents represented 65% Population. There was a male predominance with a male-to-female ratio of 1.85 (37/20). The average consultation time was 3 weeks, with extremes of 2 days and 8 weeks. Clinically, motor deficit, bladder-sphincter disorders and lower back pain were the main reasons for consultation. The most common FRANKEL classification was stages A in 52.3%, C and D in 14.3% each and finally stages B and E which were found in 9.5% each. Spinal CT was performed in 31 children and spinal MRI in 26 children, of which the following are some examples.

Topographically, the lesions predominated at the dorsal level with a percentage of 59.6% (n = 34 cases) followed by the cervical level with a percentage of 17.5% (n = 10 cases). The dorsolumbar location was found in 14% (n = 8 cases), and cervico-dorsal in 8.7% (n = 5 cases).

Fifty-two children, or 91.2% of patients, received surgical treatment. This consisted of laminectomy in most children and sometimes combined with osteosynthesis, mainly in adolescents, or orthopedic retention in younger children. The outcome was favorable in 80% of patients, with recovery of walking in 65% of patients, and 15% of patients remained stationary.

In 15% of patients, there were complications of decubitus with two cases of suppuration of the surgical wound and two cases of thrombophlebitis which were treated. All patients received physiotherapy.

Etiologically, infectious causes predominated with 71.93% (n = 41 cases), followed by tumor causes which represented 28.07% (n = 16 cases). The main germs found were Mycobacterium tuberculosis, Proteus mirabillis and Staphylococcus aureus. Pott’s disease alone was found in 61.4 (n = 35) of these infectious etiologies.

The frequency of non-traumatic slow spinal cord compression in children is difficult to assess in the literature due to the lack of studies specifically concerning this age group. The annual frequency was 4.38 cases in our series and adolescents represent 65% of the population. This is consistent with the results of some authors [5] . The male predominance observed in our series is consistent with the literature [3] [5] .

Clinically, motor deficit, bladder-sphincter disorders, and low back pain were the main reasons for consultation. In general, clinical symptoms differ little from those in adults, but it is more difficult to demonstrate spinal or radicular pain in young children. The appearance of gait disturbances, more specifically motor deficits, remains the most worrisome sign for parents. Low back pain associated with sphincter disorders in a child should prompt a diagnosis. In our environment, the absence of local health structures and the lack of financial means to pay for a consultation are responsible for a delay in diagnosis which makes the treatment ineffective and thus compromises the functional prognosis of the patient.

Spinal cord imaging remains the fundamental diagnostic examination [6] [7] . It was performed in 84% of cases in Morocco [5] . In our series, 45.6% of patients had recourse to spinal cord MRI because it is still very expensive in our regions. This partly explains the numerous indications for CT in our series. The latter remains the first examination of our spinal sphere due to its emergency availability and its excellent qualities concerning the visualization of the bone. However, standard frontal or profile radiography retains its place in infectious pathologies. It provides an etiological orientation by showing a bone modification. In our series, the dorsal site remains predominant. This is in line with pediatric studies where infectious lesions predominate [8] .

Unlike in northern countries where tumor causes predominate [2] , in sub-Saharan Africa, infectious etiologies remain predominant [3] [4] . Tuberculosis remains a public health problem. Treatment of Pott’s disease is medical and/or surgical with anti-tuberculosis drugs for at least 12 months. Several other rare etiologies have been reported in children in recent years. Aka et al. [9] reported acute myeloid leukemia in a 14-year-old adolescent while AK Doléagbénou et al. [10] [11] found cervical spine involvement in Langerhans histiocytosis in an 8-year-old child.

The treatment of spinal cord compression remains essentially surgical. It relies on relieving radiculomedullary compression as quickly as possible. In our series, it was performed in all children at the dorsal level. This is explained by the difference in the etiologies of the studies. However, laminectomy remains the treatment of choice. It is performed in an emergency context. This is low compared to the literature [1] [9] [10] . Laminectomy allowed tumor excision in 3 patients, biopsy and cystectomy in three patients each. While several authors agree on the role of laminectomy, it can be discussed if the diagnosis is late, as cure is uncertain. We noted no cases of surgical revision. Medical treatment was initiated in all patients for analgesic and inflammatory purposes. Five children did not benefit from surgery. This is partly explained by the fact that the predominant infectious causes in our series sometimes require medical treatment with antibiotics or antituberculosis drugs. Postoperative complications were mainly decubitus complications occurring in tetraplegic patients. The two children with lower limb thrombophlebitis received curative-dose anticoagulant therapy with good progress. Mobilization and verticalization remain the best prevention of limb complications. Suppuration occurred in patients with dorsal potitis and poor postoperative home hygiene. Treatment consisted of debridement combined with appropriate antibiotic therapy.

The prognosis is generally good when treatment is administered early. Surgical treatment achieved decompression and halted the progression of the compression. It promoted the regression of concomitant disorders. Recovery of walking was satisfactory in 65% of cases. The outcome is more favorable in children than in adults. Children have a high capacity for bone marrow recovery. In our series, rehabilitation is indicated in all patients with deficits and within a short period after surgery.

4-year-old child complaining of dorsal hump and progressive paraplegia. The Figure 1 shows the presentation aspect of the deformation causes by kyphosis.

Computed tomography imaging of the spine reveals a discovertebral osteolytic lesion at D9D10 with kyphosis as shown in Figure 2 .

The surgery was performed with two levels of laminectomy plus fixation, after physiotherapy during the temporal follow-up, it recovers the neurological deficit.

Slow non-traumatic spinal cord compression in children is an emergency diagnosis. In Senegal, infectious etiologies remain predominant, with Pott’s disease at the forefront. It is important to strengthen primary and secondary prevention and improve the socioeconomic conditions of the population.