Acute central cervical cord syndrome caused by minor trauma

Pediatric Spinal Trauma: Vertebral Column and Spinal Cord Injuries in Children

“…Flexion, extension, rotation, axial loading, and distrac tion have all been implicated. Ischemic injury to the spi nal cord from vertebral artery injury, anterior spinal artery injury, and focal ischemia have also been documented [32,34,45,51,53,[56][57][58][59][60][61]. Compression of the vertebral artery from inversion of the posterior arch of the atlas into the foramen magnum has also been the orized as a possible mechanism of sudden infant death [40,52,53].…”

“…In middle-aged and elderly pa tients, spondylotic changes may create SCI without demonstrable osseous injury [28], causing an acute cen tral cord syndrome. The mechanisms of injury and clini cal course of these older patients are distinct from those seen with SCIWORA [13,15,17,24,27,28,34,[85][86][87], Specific data about the severity of neurological inju ries, vertebral levels, and ages are available from 104 of the 201 reported cases of SCI WORA( fig. 3, table 3) [1, 3, 4, 6, 7, 13, 18, 19, 23, 25, 27, 28, 33, 34, 36-38, 41, 45, 48, 63, 71, 72, 83, 84, 87-90].…”

“…Flexion-extension radiographs and MR imaging or myelography is needed to assess for the presence of spi nal instability or compressive lesions in patients with SCIWORA. Myelography, reported in 20% of SCIWORA patients, has a low yield in demonstrating treatable lesions [3,28,34,36,38,41,45,54,58,63,83,90]. Nonetheless, the most common myélographie find ings are widening of the spinal cord, partial or complete blocks and normal studies.…”

“…Extravasation of dye, presumably from a traction injury, is a particularly poor prognostic finding [3,36,48,63]. MR imaging has only been used occasionally to evaluate SCIWORA [19,34,37,87], Segmental areas of cord swelling have been reported [91]. Prospective studies are in progress.…”

“…SCIWORA patients with a delayed onset of neuro logical deficits or a progression of existing neurologic dysfunction appear to have a poor prognosis [18,28,33,34,37,38,45,58,88,90). Pang et al [28] reported the highest incidence of delayed onset of deficits (22%).…”