Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations

Konovalov, Nikolay; Peev, Nikolay; Zılelı, Mehmet; Sharif, Salman; Kaprovoy, Stanislav; Тimonin, S Yu

doi:10.14245/ns.2040404.202

Cited by 27 publications

(30 citation statements)

References 72 publications

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“…Prior studies, such as Reilly et al (published 2007) had commented on the lack of well-established protocols with regards to management and treatment approaches [ 17 ]. The distinctive cervical anatomy, mechanisms of injury, as well as inconclusive imaging modalities, create an ongoing challenge to establish agreed-upon protocols for pediatric cervical spine trauma patients [ 17 - 19 ]. However, a great collaboration by a panel of fellowship-trained physicians, the Pediatric Cervical Spine Clearance Working Group published a report in 2019 which provides guidance in institutional cervical spine clearance protocols [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, a great collaboration by a panel of fellowship-trained physicians, the Pediatric Cervical Spine Clearance Working Group published a report in 2019 which provides guidance in institutional cervical spine clearance protocols [ 18 ]. The guide takes into account that the management of traumatic pediatric upper cervical spine injuries is guided based on a variety of factors, including but not limited to the type and mechanism of injury, age of patient, clinical assessment (including neurological status, Glasgow coma scale), and imaging findings [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…In cases of severe cervical spine fractures or dislocations, unstable injuries, or progressive deformity, surgical interventions via internal fixation or surgical decompression are warranted as definitive treatment [ 14 , 19 , 25 ]. The innate pediatric cervical anatomy may pose a greater challenge for pin or screw placement when compared to the adult spine [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center

Hasan¹,

Waheed²,

Suhrawardy³

et al. 2022

Cureus

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Background Traumatic upper cervical spine injuries (tUCSI) are generally caused by high-impact injuries to the C1-C2 vertebral level. The current literature is limited with regards to comparing epidemiological trends, treatment options, and overall outcomes for tUCSI within the pediatric cohort. The purpose of this study was to analyze pediatric tUCSI epidemiological data, potential variations in treatment and patient outcomes, and to evaluate any specific trends that may be clinically relevant. Methodology We conducted a retrospective cohort study on pediatric patients ages 1 day to 16 years old, admitted for tUCSI over the past 10 years (1/2011 to 1/2021) at a Midwest level 1 trauma center. Retrospective data was queried using ICD-9 and ICD-10 diagnosis codes for tUCSI. Children were stratified into three age groups: Group 1 - Infants and Toddlers (children under three years of age); Group 2 - Young Children (children between three and seven years of age); Group 3 - Juveniles and Adolescents (children between the ages of seven and 16). Numerical data and categorical variables were summarized and the normality of the distribution of data was evaluated using the Anderson-Darling normality test. Differences between the age groups were examined using either an unpaired, independent Two-Sample t-test or Unpaired Mann-Whitney U test. Pearson’s chi-squared or Fisher’s exact tests were used to compare categorical data between groups. Results Forty total patients were included in the final analysis, 23 female (57.5%) and 17 male (42.5%). The mean age was 11 ± 4 (range 2-16). Overall, the most common mechanism of injury was a motor vehicle collision (n=16, 40%), followed by sports injury (n=13, 32.5%), falls (n=6, 15%), and unknown mechanism (n=5, 12.5%). The most common mechanism of injury in young children was a fall (n=4, 57.5%, p <0.001). Adolescents and Juveniles significantly suffer from sports injuries compared to young children (n=13, 39.4%, p =0.043). Mechanisms of injuries presented with unique associated concomitant injuries. The most common associated sites of injuries were lower cervical spine (n=31, 77.5%), and skull injury (n=4, 10%). The vast majority of these cases were managed nonoperatively (pain medication and non-operative cervical orthosis) (n=36, 90%). Mortality and morbidity rates from tUCSI were rare in our cohort (n=1, 2.5%). Conclusion This study found that the majority of pediatric tUCSI patients can be managed nonoperatively, with dislocations and spinal instability being the most common indications for operative management. Commonly used non-operative external fixation methods include cervical collars and Minerva jackets. Our cohort showed very low mortality and morbidity rates, however, these preliminary results will require validation by future prospective multicenter studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center

Hasan¹,

Waheed²,

Suhrawardy³

et al. 2022

Cureus

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“…An initial radiograph and Computed Tomography (CT) scan are initially recommended to be done [12,[16][17][18]. However, those imaging tests will not find any pathological changes in these patients.…”

Section: Current Diagnosis and Prognosis Of Sciwora-type Injuriesmentioning

confidence: 99%

“…If we consider our current definition of SCIWORA as the paediatric SCI which appears as a consequence of a traumatic injury, showing clinical signs and symptoms of spinal cord damage without abnormalities showed at the available imaging tests, we can guess that MRI, during the past decades, has become the gold standard to exclude other traumatic leading causes of SCI, different from SCIWORA. Therefore, MRI has not only become the acutest tool to achieve the final diagnosis of SCIWORA, but also to stand the treatment management and prognosis of each type of injury, according to its findings or even "no findings" showed [12,17]. In this way, MRI has been able to demonstrate the visualization of the damage of the soft tissues that explains the biomechanical and anatomical disruption of the spine.…”

Section: Current Diagnosis and Prognosis Of Sciwora-type Injuriesmentioning

confidence: 99%

Pediatric SCIWORA-Type Injuries Revisited: What Should be the Most Discerning Definition of SCIWORA at the Current Days?

López-Dolado

2021

OPROJ

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The traditional concept of "SCIWORA" is nowadays being reassessed due to the accumulation of clinical knowledge and the improvement in diagnostic accuracy to study this entity. In the current era of magnetic resonance imaging as the gold standard in spinal pathology, particularly the diffusion tensor imaging scanning, the present article aims to respond the challenge of critically reviewing and redefining this entity as accurately as possible. Another important fact will be to discuss the best treatment option for these patients, because while conventional approaches agreed with a conservative management, some modern streams of thought defend an early surgical procedure to avoid a worst prognosis in selected cases.

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Traumatic Spinal Injuries in Children

Floan

Ignacio²,

Mooney³

2022

Pediatric Trauma Care

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Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations

Cited by 27 publications

References 72 publications

Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center

Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center

Pediatric SCIWORA-Type Injuries Revisited: What Should be the Most Discerning Definition of SCIWORA at the Current Days?

Traumatic Spinal Injuries in Children

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