Pediatric Spinal Cord Injury without Radiographic Abnormality

Abstract

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.

Spina Bifida Occulta Is a Risk Factor for Spinal Cord Injury Without Fracture or Dislocation for Children Performing a Backbend During Dance

“…Road accidents (37%) and sports accidents (31%) were identified as the main causes of SCI by a systematic review ( 16 ). While backbend during the dance was the main cause of children SCI in China in the present study which is similar to the study by Zou et al ( 4 ).…”

“…Compared with previous studies in other countries, the obvious difference was the demographic factors, which were in accordance with the results of Zou et al ( 4 ). The age of SCI for this study was younger than compared with other studies (5.8 vs. 9.78 years), besides, the male-to-female ratio was 1:2.7, indicating a slightly higher incidence of females compared with other countries in which the male-to-female ratio was 1.8–3.3:1 ( 2 , 9 ).…”

“…Previous studies demonstrated the leading etiologies of spinal cord injury (SCI) without fracture or dislocation, including motor vehicle accidents, falls, sports, and child abuse in western countries ( 2 ). While that appeared different in China, dance injury has been supposed to be the main cause ( 3 , 4 ). In 2019, Liang et al ( 5 ) reported three cases of pediatric SCI caused by minor trauma and suggest that spina bifida occulta (SBO) might be a predisposing factor for SCI without fracture or dislocation.…”

Analysis of the Curative Effect and Prognostic Factors of Anterior Cervical Surgery for Spinal Cord Injury without Radiographic Abnormalities

“…Spinal cord injury without radiographic abnormalities (SCIWORAs) refer to the cervical spinal cord injury in which a patient has clinical symptoms of cervical spinal cord and nerve injury, but there is no imaging manifestation such as fracture and dislocation on X-ray and CT [ 1 , 2 ]. Patients without fracture-dislocation type cervical spinal cord injury are not uncommon in clinic, and the incidence shows an increasing trend along with the aging of the population [ 3 , 4 ]. SCIWORA is mostly caused by mild and moderate external forces, and clinical treatment is often divided into two ways, i.e., surgical treatment and conservative treatment.…”

Letter to the Editor: Pediatric Spinal Cord Injury Without Radiographic Abnormality: The Beijing Experience

“…We read with great interest the article published by Zou et al 1 entitled “Pediatric Spinal Cord Injury without Radiographic abnormality: The Beijing Experience." We commend and congratulate the authors’ work on pediatric spinal cord injury without radiographic abnormality (SCIWORA).…”