Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) in Children

Pang, Dachling; Eibach, Sebastian

doi:10.1007/978-3-319-31512-6_134-1

Cited by 2 publications

(9 citation statements)

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“…15 These characteristics lead the pediatric vertebral column to be inherently malleable, and such physiological hypermobility allows the vertebral segments to be displaced away from each other to some extent and return to their original positions without fracture, but as a consequence the enclosing spinal cord becomes susceptible to injury from flexion, hyperextension, longitudinal distraction, and ischemia. 14,15 Moreover, the relatively large headto-neck ratio in infants predisposes their cervical spine to instability when subjected to traumatic forces, which increases their chance of flexion and hyperextension SCI. 15 Since the term SCIWORA was introduced in 1982, many hospitals and institutions have performed retrospective studies on SCIWORA in children to better prevent, diagnose, and treat the associated types of SCI.…”

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confidence: 99%

Pediatric Spinal Cord Injury without Radiographic Abnormality

Zou

Teng

Huang

et al. 2021

Spine

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Study Design. Retrospective study. Objective. To describe the epidemiology and clinical outcomes of pediatric patients with spinal cord injury (SCI) without radiographic abnormality (SCIWORA) in mainland China for the first time. Summary of Background Data. SCIWORA is a syndrome that often occurs in children mainly due to the unique biomechanics of the pediatric spine. Although there have been numerous retrospective studies on pediatric SCIWORA, and mainland China has more patients with SCI than anywhere else, pediatric patients with SCIWORA in mainland China has not been described in any study. Methods. Review of all cases with SCIWORA at Beijing Children's Hospital between July 2007 and December 2019. Results. Of the 189 pediatric patients with SCI 140 had SCIWORA (age: 5.65 AE 2.60 years, male-to-female ratio: 2:5). Main causes of injuries were sports (41%, mostly backbend), falls (27%), traffic accidents (10%), and violence (8%). Lesions were located at the thoracic (77%), cervical (10%), multiple (5%), and lumbar (4%) levels. Incubation period was 2 AE 6 hours.hours. Pathological characteristics of SCI were detected in 96% patients by magnetic resonance imaging (MRI). Based on the American Spinal Injury Association impairment scale (AIS), many patients had complete impairment (50% AIS A, 45% AIS B/C/D, 1% AIS E). Particularly, the five patients with normal MRI tended to have mild injury (AIS D) (P < 0.001), but they still showed abnormal reflex. In the one patient who could not be graded at all by AIS, his only functional deficits were abnormal upper and lower limb muscle tones. A total of 59% patients were treated with methylprednisolone, dexamethasone, or both. Out of 76 patients 59 showed neurological improvement before discharge. The only association among age, cause of injury, level of lesion, incubation period, AIS grade, type of corticosteroid therapy, and neurological improvement was between level of lesion and AIS grade (P < 0.001). Conclusion. Demographic and clinical differences exist in patients with SCIWORA. MRI and detailed neurological examinations should both be performed for proper diagnosis. There is still a need to develop better treatment strategy for these patients.

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confidence: 99%

Pediatric Spinal Cord Injury without Radiographic Abnormality

Zou

Teng

Huang

et al. 2021

Spine

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“…This includes joint capsules, paraspinal ligaments and intervertebral discs. [2][3][4][5]7 Bony stability is also reduced compared to the adult spine due to shallow, more horizontally oriented facet joints, absent uncinate processes and anterior wedging of the vertebral bodies. 3 Lastly, due to the relatively large head in the paediatric population, the cervical spine is subjected to greater bending forces during flexion and extension, placing it at greater risk for more severe injuries.…”

Section: Discussionmentioning

confidence: 99%

“…1 The term SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) was popularised by Pang and Wilberger in 1982 2 and was defined as 'objective signs of myelopathy as a result of trauma, whose plain films of the spine, tomography, and occasionally myelography carried out at the time of admission showed no evidence of skeletal injury or subluxation'.…”

Section: Introductionmentioning

confidence: 99%

“…The 'Segmental Spinal Instability' theory states that, following SCIWORA, the injured spinal column is prone to re-injury, even in the absence of any objective clinical or radiographic features of instability, including MRI. 2,3 The contradicting 'differential stretch hypothesis' is based on the fact that the inherently mobile paediatric spine will deform elastically under significant tension, exceeding the elastic deforming potential of the more fragile spinal cord, causing damage or rupture to the cord, but returning to baseline stability by elastic recoil. 4 Proponents of the 'segmental spinal instability theory' recommend immobilisation of the affected spinal segment in a rigid brace for 12 weeks following injury, regardless of the presence of radiographic signs of instability.…”

Section: Introductionmentioning

confidence: 99%

“…4 Proponents of the 'segmental spinal instability theory' recommend immobilisation of the affected spinal segment in a rigid brace for 12 weeks following injury, regardless of the presence of radiographic signs of instability. 2,3 Those supporting the 'differential stretch hypothesis', on the other hand, recommend that protection in a soft collar for 2 weeks is sufficient and that bracing is unnecessary and does not prevent recurrence. 4,5 Rigid immobilisation of the spine, especially the cervical spine, is not without complications and is therefore best avoided if not indicated.…”

Section: Introductionmentioning

confidence: 99%

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Ligamentous integrity in Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case series

et al. 2017

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Purpose of study: Prolonged bracing following injury in patients with Spinal Cord Injury without Radiographic Abnormality (SCIWORA) remains controversial. Some authors claim that there is occult instability and a risk of recurrent injury whereas others propose that the spinal column will deform elastically, but will return to its baseline stability by elastic recoil. We aim to assess the presence of ligamentous injury on MRI and the incidence of recurrent instability following SCIWORA in order to determine the need for prolonged bracing.Methods: A retrospective chart review was performed for a series of 12 patients with documented SCIWORA that presented to Red Cross Children's Hospital over the past 8 years. Details regarding mode of injury, age at presentation, neurological deficit at presentation, MRI findings and long-term prognosis were documented.Results: There were nine males and three females. The median age was 4.35 years. All patients were victims of high energy motor vehicle accidents. In two patients there was disruption of the ligamentum flavum at the level of the injury. There were no episodes of recurrent instability or neurological compromise in those patients that had recovered. None of our patients had rigid bracing following the diagnosis of SCIWORA. Conclusion:Infrequently observed disruption of isolated stabilising structures in SCIWORA did not lead to early or delayed instability in our patients. We did not find evidence to support the practice of prolonged rigid bracing to prevent recurrence following SCIWORA. Level of evidence: Prognostic case study, level IVKey words: SCIWORA, paediatric spinal cord injury, MRI findings in SCIWORA, bracing in SCIWORA, paediatric trauma http://dx

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Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) in Children

Cited by 2 publications

References 58 publications

Pediatric Spinal Cord Injury without Radiographic Abnormality

Pediatric Spinal Cord Injury without Radiographic Abnormality

Ligamentous integrity in Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case series

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