Clinical diagnosis and treatment of spinal cord injury without evidence of abnormality in children: a review

Abstract

Spinal cord injury without radiological abnormality (SCIWORA) is a challenging circumstance in all age groups. Symptoms in some children of SCIWORA does not develop at the time of trauma. Different treatment methods (steroid therapy, immobilization, surgery) applied to treat SCIWORA, but with different prognosis. SCIWORA diagnosed when X-rays and computed tomography (CT) normal; however, initial magnetic resonance imaging (MRI) sometimes can be expected. Performing diffusion-weighted imaging (DWI) with early conventional MRI is a gold standard in the diagnosis of SCIWORA. Early MRI and DWI provides a quick diagnosis to facilitate recovery, ensure a superior clinical outcome, and choose a proper treatment method. Although it provides an accurate diagnosis, early immobilization with steroid therapy can present a good prognosis but not in all cases. Durotomy with duraplasty had a good outcome in adult patients, which might be helpful in children. This review explores the current and future methods of diagnosis and treatment of SCIWORA in children.

Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version)

“…MRI can show displaced disk fragments and ligamentous injury as well as spinal cord edema and hemorrhage on T2-weighted sequences [24]. Range of hemorrhage and edema and degree of spinal cord compression on MRI are associated with neurological prognosis [25,26]. Evaluation of both preoperative and postoperative MRI is more helpful in predicting neurological outcome [27].…”

“…Pediatric SCI without radiographic abnormality (usually caused by backbends during dancing in China), acute hyperextension myelopathy, and surfer's myelopathy are often characterized by spinal venous hypertension and SCCS or SCImH [25,73]. Early decompression is recommended in these patients.…”

“…The clinical diagnosis of intermediate and chronic SCI includes determining the level and severity of injury, quality of life, and any remaining spinal cord compression [21][22][23][24][25]28]. Neurophysiological examination and MRI may assist in understanding structural abnormalities and assessing motor and sensory function [23][24][25]28].…”