Errors in the Diagnosis of Spinal Cord Isolated Injury in Children

Abstract

One of the features of traumatic spinal cord injury in children is a high probability of the isloted form of its injury (syndrome SCIWORA – spinal cord injury without radiograph abnormality). Mobility and elasticity of the spine column in childhood explains a relatively rare incidence of its injury in young children; however, we meet a high incidence of the isolated spinal trauma in this group of patients. According to various authors, SCIWORA is more common in children under the age of 5 ~ 64%; from 6 to 12 ~ 35%; over 12 – about 20%. The relevance of the present study is explained by errors in the isolated spinal cord injury diagnostics and by the lack of clear clinical and diagnostic algorithm optimizing SCIWORA verification in this category of patients. Aim. To analyze the level of SCIWORA diagnostics in children with spinal cord injury (SCI) in a specialized surgical hospital as well as to assess reasons of misdiagnostics. Material and methods. 167 children with SCI were included into the study. They were admitted to the Clinical and Research Institute of Emergency pediatric Surgery and trauma (CRIEpSt) in 2014-2020. Depending on the time of admission, patients were divided into two groups: Group I – children who were admitted to the hospital within the first month after injury; Group II – children who were admitted later. Children aged 12.2 ± 5.0 y.o., in average. All patients were examined for their neurological status by ASIA scale; they also had radial diagnostics: computed tomography (CT) and magnetic resonance imaging (MRI). Results. The isolated spinal cord injury (SCIWORA) was revealed in 6.0% of children with SCI who were admitted to CRIEpSt in 2014 – 2020. The greater number of SCIWORA (60%) occurred as a result of road accidents and was recorded in the thoracic region (50%). Isolated the soinal cord injury occured more often in the age groups under 5 y. o. and 5 – 12 y.o. (by 40% in each age group). The severity of spinal cord injury in SCIWORA depends on the very mechanism of such damage: A – 80%, B – 20% by ASIA scale. In SCIWORA, computed tomography does not allow to fully assess SCI severity. MRI is prescribed for more precise diagnostics: to clearly visualize damages to the ligamentous apparatus and intervertebral discs; in addition to clinical findings to confirm contusion, hematomyelia, partial or complete rupture of the spinal cord; to make rehabilitation prognosis using tractography. Conclusion. The reasons for errors in the isolated spinal cord injury diagnosis in children is a result of underestimated severity of child’s condition due to his/her young age or due to the combination of SCI with severe traumatic brain injury (TBI) with a reduced state of consciousness. In case of even a slight suspicion of isolated spinal cord injury, the diagnostic algorithm in little children or in patients with reduced consciousness state should include a “head-to-toe” CT scanning and MRI examination in addition to a full-fledged neurological examination.