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Spinal cord injury without radiographic abnormality (SCIWORA) in children

Julie C Leonard, MD, MPH
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


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 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 on presentation or a history of transient paresthesias, numbness, or paralysis. Approximately half of patients presented with delayed onset (up to four days after injury) of permanent paralysis.

However, with 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 [2].

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.

SCIWORA should not be confused with cervical "burners" or "stingers", which refers to peripheral brachial plexus injuries, typically at the C5-C6 level resulting from trauma to the neck and shoulder (table 1). When children present with transient neurologic symptoms and normal neurologic exams, it may be difficult to distinguish between brachial plexus injuries and SCIWORA, leading to over-reporting of SCIWORA [5]. (See "Overview of cervical spinal cord and cervical peripheral nerve injuries in the child or adolescent athlete", section on 'Cervical burners'.)

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Literature review current through: Dec 2017. | This topic last updated: Dec 22, 2017.
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