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Spinal cord injuries without radiologic abnormality in children: a systematic review
T Carroll1, C D Smith1, X Liu1
1Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH, USA.
Insights
Pediatric spinal cord injuries without radiologic abnormality (SCIWORA) are most commonly caused by sports injuries. Initial severe impairment (AIS grade A) predicts poorer outcomes in children compared to adults.
Area of Science:
- Orthopedics
- Neurology
- Pediatric Medicine
Background:
- Spinal cord injuries without radiologic abnormality (SCIWORA) are a distinct clinical entity.
- Understanding the epidemiology and outcomes of pediatric SCIWORA is crucial for effective management.
Purpose of the Study:
- To systematically review pediatric SCIWORA cases.
- To investigate the relationship between initial neurologic impairment and final neurologic status.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searched PubMed and OvidSP for pediatric SCIWORA cases.
- Recorded patient demographics, injury mechanisms, spinal cord levels, MRI findings, and American Spinal Injury Association (AIS) impairment scales.
Main Results:
- Identified 433 pediatric SCIWORA cases.
- Sports injuries were the most common cause (39.83%), followed by falls and motor vehicle accidents.
- Mean improvement was 0.89 AIS grades.
Conclusions:
- Sports-related injuries and cervical SCIWORA are most frequent in children.
- Pediatric patients with initial AIS grade A had worse outcomes than adults.
- Initial AIS grade D indicated a high likelihood of full recovery (AIS E).
Study Design:
Systematic review.
Objectives:
The objective of this study is to systematically review the literature for pediatric cases of spinal cord injuries without radiologic abnormality (SCIWORA) to investigate any possible relationship between initial neurologic impairment and eventual neurologic status.
Setting:
A university department of orthopedics.
Methods:
Following the preferred reporting items for systemic reviews and meta-analysis (PRISMA) guidelines for systematic review, the databases of PubMed and OvidSP were electronically searched for articles that use individuals under 18 years old, have trauma resulting in spinal cord injury and have no fractures or dislocations on radiographs. When available, the patients' age, sex, mechanism of injury and spinal cord level were recorded. Individuals with cervical injury, who had specific information on cervical level and mechanism of injury, were recorded as well. Patients who reported specific magnetic resonance imaging findings and the time from the injury were also reported. When possible, the American Spinal Injury Association Impairment Scale (AIS) was determined initially after the injury and then at last follow-up.
Results:
A total of 433 pediatric patients were identified with SCIWORA. The most prevalent mechanism of injury was sports-related injury cases (39.83%) followed by fall (24.18%) and motor vehicle-related (23.18%) injuries. The mean improvement recorded for all patients was 0.89 AIS grades.
Conclusion:
The most common mechanism of injury was sports-related and cervical injury, which occurred more frequently than other levels. Initial AIS grade A showed poorer outcomes in the pediatric population compared with the adult population. Initial presentation of D showed the highest likelihood of no permanent neurologic impairment (AIS of E).
