Spinal Cord Injuries without Radiographic Abnormality at Two Pediatric Trauma Centers in Ontario

Abstract

Background: Spinal cord injury without radiographic abnormality (SCIWORA) represents a traumatic myelopathy, either transient or permanent, that is not associated with visible vertebral fractures or ligamentous abnormalities on plain radiographs or CT. MRI has become essential in the diagnosis and evaluation of trauma patients and in predicting the long-term neurological outcome. Methods: The medical charts of 578 children with vertebral trauma at the Children’s Hospital of Eastern Ontario and the Hospital for Sick Children were retrospectively reviewed. Results: Forty-five patients were identified as having traumatic myelopathy. Three of these patients had SCIWORA. Two sustained thoracic spinal cord injuries as a result of motor vehicle accidents and permanent neurological deficits. The third was involved in a sports-related injury and sustained a cervical spine injury that improved in 48 h. Conclusions: SCIWORA is uncommon. The serious neurological sequelae that can result from a missed diagnosis merit more attention in identifying a spinal lesion in children with traumatic myelopathy. MRI has played a valuable role in this respect and may be even more predictive of outcome than the presenting neurological findings. The SCIWORA acronym can be modified to SCIWONA (spinal cord injury without neuroimaging abnormality) in order to highlight the importance of MRI in the prognosis.

Traumatic spinal injuries in children at a single level 1 pediatric trauma centre: report of a 23-year experience

“…19 We identified 2 (6%) cases of SCIWORA in the patients with myelopathic changes (n = 34), which is within the wide range of published estimates of SCIWORA in the pediatric population with reported ranges of 1.3%-38%. 5,8,11,20 The positive MRI results of these 2 patients assisted in the identification and prognosis of their injuries.…”

“…Trigylidas and colleagues 20 found that 10% of myelopathic patients presented with associated head injuries and that 50% of these head injuries occurred in patients with SCIWORA.…”

“…The location of injury in patients with SCIWORA commonly involves the cervical cord, 20,21 but may also occur in the thoracic spine in association with high-energy trauma, 22,23 such as MVCs. Trigylidas and colleagues 20 found that 10% of myelopathic patients presented with associated head injuries and that 50% of these head injuries occurred in patients with SCIWORA.…”

An Update Review of Epidemiology, Anatomy, Classification, Management and Outcome of pediatric Thoracolumbar Spine Trauma

“…They have proportionately bigger skulls matched by their bodies and have immature cervical musculature (22). They similarly have innate ligamentous laxity, elasticity, and imperfect ossification (23).…”

Delayed Diagnosis of Neurological Bladder following Spinal Cord Injury without Radiological Abnormality

“…Spinal cord injury without radiological abnormality (SCIWORA) is a specific entity, which has been described since the early 1980s, and its estimated incidence in children ranges between 19 and 34% [1]. Its pathophysiological mechanism derives directly from the specific anatomical features of the paediatric spine [2,3,4]. The spinal lesions are caused by longitudinal distraction and ischaemia [4].…”