Spinal Cord Injury without Radiographic Abnormality in Children-The SCIWORA Syndrome

Traumatic cervical instability associated with cord oedema and temporary quadriparesis

“…SCI-WORA is most likely to occur in blunt cervical trauma of children beyond the age of 8 years because of the high elasticity of the paediatric spine, resulting from unique anatomic and biomechanical properties. 6,12,13,18,19 In adults, cervical spinal cord injury usually is associated with bony malalignment, locking of facets, disruption of the vertebral body or fracture of elements of the neural arch. Since the introduction of MRI, a post-traumatic abnormality can frequently be depicted in the spine of SCIWORA patients.…”

“…19 In the adult, SCIWORET is encountered more frequently than SCIWORA syndrome, even though both conditions are rare. 9,10,12,19 In recent years, the radiological assessment protocol for acute cervical spine trauma was challenged: increasingly the three standard radiological views are combined with MRI or helical CT of the complete cervical spine instead of conventional CT. [5][6][7] Especially in patients with neurological dysfunction, MRI probably is the first radiological modality to be applied. 4,5 Multiplane MRI not only depicts eventual neurocompression and discoligamentous injury, it may also show haematomyelia, cord transection and cord oedema.…”

“…6,15 Since discoligamentous disruption may be invisible in the radiological evaluation, the clinical findings and the radiological aspect of the cord nevertheless raise the suspicion of discoligamentous insufficiency that usually can be confirmed in the cooperative patient by active dynamic flexion and extension lateral radiographs. 2,12 Since MRI reliably depicts the location of the cord lesion, its rostral and caudal ends and the eventual presence of intra-axial haematomas, MRI, together with the clinical presentation, play an important role in the prognosis of the respective cord lesion. 4,5,[7][8][9]11,[13][14][15] Patients with a high intense cord lesion in T2-and a low intense lesion in T1-weighted MRI fare worse than patients with a lesion in T2-weighted images alone.…”

“…4,10,11 The latter may be indicative of an unstable cervical spine with the danger of ongoing cord damage. 12 Such conditions can be validated in the reliable patient by means of dynamic flexion and extension lateral radiographs. 2 Unstable cervical motion segments require a fusion procedure to avoid ongoing damage.…”

“…2 Unstable cervical motion segments require a fusion procedure to avoid ongoing damage. 12 SCIWORA-type injuries are very unlikely to occur in elderly people. In this age group such injuries are usually associated with radiological evidence of major spondylotic changes allowing for significant traction or compression of the cord during the accident and/or bony lesions and malalignment.…”