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Published on: May 7, 2015
Pediatric spinal cord injury without radiographic abnormality in the era of advanced imaging
Caitlin A Farrell1, Megan Hannon, Lois K Lee
1aDivision of Emergency Medicine bDepartment of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Pediatric spinal cord injury without radiographic abnormality (SCIWORA) is rare but requires high suspicion and advanced imaging like MRI for diagnosis and prognosis. Treatment involves nonoperative management with immobilization and physical therapy.
Area of Science:
- Pediatric neurology
- Radiology
- Trauma surgery
Background:
- Pediatric spinal cord injury without radiographic abnormality (SCIWORA) presents a diagnostic challenge due to its rarity and normal initial imaging.
- Understanding SCIWORA is evolving with increased use of advanced imaging techniques.
Purpose of the Study:
- To review current evidence on pediatric SCIWORA, including definition, epidemiology, clinical presentation, and outcomes.
- To highlight the role of MRI in diagnosing and prognosing SCIWORA.
- To outline current management strategies for pediatric SCIWORA.
Main Methods:
- Literature review of current evidence on pediatric SCIWORA.
- Analysis of case studies and national databases to define epidemiology and outcomes.
- Examination of MRI findings in SCIWORA patients.
Main Results:
- Widespread MRI use has improved the understanding of SCIWORA patterns and prognostic stratification.
- Epidemiology and outcomes of SCIWORA have been further defined through recent studies.
- MRI is diagnostically and prognostically valuable for patients with persistent symptoms despite negative conventional imaging.
Conclusions:
- High clinical suspicion is crucial for prompt advanced imaging in suspected pediatric SCIWORA.
- MRI is essential for diagnosis and prognosis in SCIWORA, especially when initial imaging is negative.
- Nonoperative management, including immobilization and physical therapy, is the standard treatment for diagnosed SCIWORA.
Purpose Of Review:
The current review describes the current evidence on pediatric spinal cord injury without radiographic abnormality (SCIWORA) with attention to the definition, epidemiology, and clinical presentation of the condition, as well as common MRI findings, management strategies, and outcomes.
Recent Findings:
Recent literature demonstrates that with more widespread MRI use, our understanding of SCIWORA has improved. The new literature, although still limited, provides a more granular conceptualization of patterns of injury as well as potential prognostic stratification of patients based on MRI findings. Through case studies and national database analyses, researchers have further defined the epidemiology and outcomes of SCIWORA.
Summary:
Although SCIWORA occurs infrequently, thus making robust research a challenge, maintaining a high suspicion in the appropriate clinical setting ought to prompt acquisition of advanced imaging. For patients with persisting neurologic symptoms after trauma, despite negative plain films and cervical spine computed tomography, MRI can be helpful diagnostically as well as prognostically. Once SCIWORA is diagnosed, patients are treated nonoperatively with hard collar immobilization and physical therapy.
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