Spinal cord injury without radiographic abnormality (SCIWORA) in children
- Alison Chantal Caviness, MD, MPH, PhD
Alison Chantal Caviness, MD, MPH, PhD
- Associate Professor of Pediatric Emergency Medicine
- Baylor College of Medicine
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
SCIWORA refers to spinal injuries, typically located in the cervical region, in the absence of identifiable bony or ligamentous injury on complete, technically adequate plain radiographs or computed tomography. The majority of children with SCIWORA do have demonstrable injury of the spinal cord, spinal ligaments, or vertebral body end plate on magnetic resonance imaging. SCIWORA should be suspected in patients subjected to blunt trauma who report early (immediate) or transient symptoms of neurologic deficit or who have existing findings upon initial assessment. Treatment and prognosis are based upon neurologic presentation and MRI findings.
This topic will review the clinical features and management of SCIWORA in children less than 18 years of age. The approach to ligamentous injury and SCIWORA in adults is discussed separately. (See "Evaluation and acute management of cervical spinal column injuries in adults", section on 'Evaluation for ligamentous injury and SCIWORA'.)
SCIWORA was first defined in a series of children as objective signs of acute traumatic myelopathy in the absence of spinal column findings on plain radiographs, flexion-extension radiographs, and/or computed tomography (CT) [1,2]. In this original report, it was noted that patients had neurologic deficits or a history of transient paresthesias, numbness, or paralysis. Delayed onset of permanent paralysis, up to four days after injury, occurred in approximately half of patients.
However, since the advent of magnetic resonance imaging (MRI) approximately two-thirds of cases described as SCIWORA in the literature actually have demonstrable injury to the spinal cord, soft tissue components of the spinal column (ligaments, capsules, or muscles), or vertebral body endplate [3,4]. With the increased availability of MRI, the diagnosis of "real" SCIWORA or spinal cord injury without neuroimaging abnormality is less common. The term "spinal cord injury without computed tomography evidence of trauma" (SCIWOCTET) is sometimes used to describe adult patients with neurologic findings suggestive of spinal cord injury with normal anatomic alignment and no bony abnormalities seen on CT .
Nonetheless, it is important to remember that patients with blunt trauma who have a history of transient neurologic symptoms that have resolved by the time of initial evaluation may have a significant injury to the spinal cord and/or spinal column despite a normal physical examination and normal spine radiographs and/or CT.
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