Surgical management of post-SCIWORA spinal deformities in children

Patients with spinal cord injury without radiographic abnormality (SCIWORA) are prone to develop spinal deformities. The purpose of this study is to report on the clinical and radiological features of post-SCIWORA spinal deformities.

Four patients with SCIWORA and spinal deformities requiring surgery were analyzed clinically and radiographically.

All four SCIWORA patients developed progressive neuromuscular scoliosis. There were 2 males and 2 females. The mean age at spinal cord injury was 3.9 years (range 6 months to 7 years). Spinal deformity was first noticed at a mean of 17 months after their initial injury (range 9 months to 2 years), and surgical intervention was performed at a mean of 6.5 years following their injury (range 4-11 years). The mean preoperative curve was 54° (range 50-62°). The mean postoperative curve was 9.5° (range 5-16°). The level of injury was T5 in two patients, and T10 and L2 in one patient each. All but the lumbar level injury patient had complete paraplegia. One patient with complete injury (T10) and another with incomplete injury (L2) improved neurologically and were able to walk with the aid of orthoses and crutches. Pelvic obliquity improved in all patients following spinal reconstruction surgery, and none of the patients required additional surgery for spinal deformity. The mean postoperative follow-up was 51.75 months (range 24-93 months).

Long scoliotic curves extending to the pelvis should be expected in SCIWORA. Early intervention may prevent severe deformities. Modern instrumentation techniques employing pedicle screws provided satisfactory correction, improved hip subluxation, and did not adversely affect the ambulatory ability or functional level of the patients in this series.