Related Experiment Video
Updated: May 6, 2026
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Spinal cord injury without radiologic abnormality in children imaged with magnetic resonance imaging
Prashant Mahajan1, David M Jaffe, Cody S Olsen
1From the Division of Emergency Medicine (P.M.), Department of Pediatrics, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit; and Departments of Emergency Medicine (A.J.R.) and Pediatrics (A.J.R.), University of Michigan Medical Center and University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Pediatrics (D.M.J., J.C.L.), St. Louis Children's Hospital (D.M.J., J.R.L., J.C.L.) and Washington University School of Medicine, St. Louis, Missouri; Department of Pediatrics (C.S.O.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Neurosurgery (J.R.L.), Division of Emergency Medicine (L.E.N.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Departments of Emergency Medicine (N.K.) and Pediatrics(N.K.), University of California, Davis, School of Medicine, Davis, California.
Insights
Children with spinal cord injury without radiographic abnormality (SCIWORA) but normal MRI findings had better outcomes than those with MRI-detected abnormalities. This highlights the importance of MRI in assessing pediatric SCIWORA severity.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Radiology
Background:
- Cervical spinal cord injury without radiographic abnormality (SCIWORA) is a diagnostic challenge in children.
- Differentiating SCIWORA based on MRI findings is crucial for prognosis.
Purpose of the Study:
- To compare clinical outcomes of pediatric SCIWORA patients with normal versus abnormal MRI findings.
- To evaluate the impact of MRI-detected cervical cord abnormalities on patient management and recovery.
Main Methods:
- A subanalysis of pediatric patients (<16 years) with blunt cervical spine injury and normal neuroimaging for bony/ligamentous injury.
- Comparison of children with clinical SCIWORA and normal MRI versus those with cervical cord signal changes on MRI.
- Epidemiologic study, level III.
Main Results:
- Of 69 SCIWORA patients, 54 (78%) had normal MRI, and 15 (22%) had abnormal MRI findings (cord signal changes).
- Patients with abnormal MRI were more likely to undergo operative stabilization (20% vs. 0%).
- Persistent neurologic deficits were significantly higher in patients with abnormal MRI findings (67% vs. 6%).
Conclusions:
- Pediatric SCIWORA patients with normal MRI findings exhibit significantly more favorable clinical outcomes.
- Cervical cord abnormalities on MRI in pediatric SCIWORA indicate a poorer prognosis and increased risk of persistent deficits.
Background:
This study aimed to compare children diagnosed with cervical spinal cord injury without radiographic abnormality (SCIWORA) relative to whether there is evidence of cervical spinal cord abnormalities on magnetic resonance imaging (MRI).
Methods:
We conducted a planned subanalysis of a cohort of children younger than 16 years with blunt cervical spine injury presenting to Pediatric Emergency Care Applied Research Network centers from January 2000 to December 2004 who underwent cervical MRI and did not have bony or ligamentous injury identified on neuroimaging. We defined SCIWORA with normal MRI finding as children with clinical evidence of cervical cord injury and a normal MRI finding and compared them with children with SCIWORA who had cervical cord signal changes on MRI (abnormal MRI finding).
Results:
Of the children diagnosed with cervical spine injury, 55% (297 of 540) were imaged with MRI; 69 had no bony or ligamentous injuries and were diagnosed with SCIWORA by clinical evaluation; 54 (78%) had normal MRI finding, and 15 (22%) had cervical cord signal changes on MRI (abnormal MRI finding). Children with abnormal MRI findings were more likely to receive operative stabilization (0% normal MRI finding vs. 20% abnormal MRI finding) and have persistent neurologic deficits at initial hospital discharge (6% normal MRI finding vs. 67% abnormal MRI finding).
Conclusion:
Children diagnosed with SCIWORA but with normal MRI finding in our cohort presented differently and had substantially more favorable clinical outcomes than those with cervical cord abnormalities on MRI.
Level Of Evidence:
Epidemiologic study, level III.
Related Concept Videos
01:24Magnetic Resonance Imaging
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:14Spinal Cord Injury ll: Pathophysiology
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:25Secondary Spinal Cord Injury llI: Pathophysiology
01:27Imaging Studies IV: Magnetic Resonance Imaging