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Multicenter study of 37 pediatric patients with SCIWORA or other spinal cord injury without associated bone lesion
David Brauge1, Benjamin Plas2, Mathieu Vinchon3
1Pôle neuroscience - neurochirurgie (neuroscience - neurosurgery cluster), faculté de médecine (faculty of medicine), hôpital de Purpan (Purpan hospital), 31059 Toulouse, France; Arts et métier ParisTech, institut de biomécanique humaine George Charpak (Institute of human biomechanics), 75013 Paris, France.
Insights
Pediatric traumatic spinal cord injuries without bone lesions, particularly spinal cord injury without radiological abnormality (SCIWORA), show variable recovery. Age and trauma mechanism are key prognostic factors for these injuries in children.
Area of Science:
- Pediatric Traumatology
- Neurology
- Spinal Cord Injury Research
Background:
- Pure traumatic spinal cord injuries, including spinal cord injury without radiological abnormality (SCIWORA), occur in children.
- These injuries, often without bone lesions, necessitate understanding their causes and outcomes.
Purpose of the Study:
- To describe the causes and clinical presentation of pure spinal cord injuries in French children.
- To identify prognostic factors for recovery.
- To outline the medical management of these injuries in France.
Main Methods:
- A multicenter retrospective case series analyzed 37 patients under 18 with traumatic medullary lesions.
- Data included accident causes, injury specifics, Frankel grade, MRI findings, treatment, and neurological recovery.
- Neurologic recovery was defined as at least a one-grade improvement in the Frankel scale.
Main Results:
- Road accidents (17) and sports accidents (11) were common causes.
- Neurologic recovery occurred in 20/30 SCIWORA cases, but not in obstetric trauma or intracranial lesion cases.
- Factors associated with SCIWORA recovery included younger age, accident type, and absence of initial MRI lesions.
Conclusions:
- Pediatric spinal cord injury without associated bone lesion is a serious condition.
- Prognosis is significantly influenced by patient age and the mechanism of trauma.
Background:
Pure traumatic spinal cord injury (without associated bone lesion) are encountered in pediatric accidentology, the most typical being spinal cord injury without radiological abnormality (SCIWORA). The present study reports a multicenter series of under-18-year-olds admitted for traumatic medullary lesion. The objectives were: (1) to describe the causes of pure spinal cord injuries in children in France and their clinical presentation; (2) to identify any prognostic factors; and (3) to describe their medical management in France.
Patients And Method:
A multicenter retrospective study was conducted in 3 pediatric spine pathology reference centers. Files of 37 patients with confirmed spinal cord injury between January 1988 and June 2017 were analyzed: SCIWORA (n=30), myelopathy associated with severe cranial trauma (n=2), and obstetric trauma (n=5). Accident causes, associated lesions, initial Frankel grade, level of clinical spinal cord injury, initial MRI findings, type of treatment and neurology results at last follow-up were collated. The main endpoint was neurologic recovery, defined by improvement of at least 1 Frankel grade.
Results:
Causes comprised 17 road accidents, 11 sports accidents, 5 obstetric lesions and 4 falls. Mean follow-up was 502 days. The rate of at least partial neurologic recovery was 20/30 in SCIWORA, 0/5 in obstetric trauma, and 0/4 in case of associated intracranial lesion. In SCIWORA, factors associated with recovery comprised age, accident type, and absence of initial MRI lesion.
Discussion:
We report a large series of pediatric spinal cord injury without associated bone lesion. This is a potentially serious pathology, in which prognosis is mainly related to age and trauma mechanism.
Level Of Evidence:
IV, case series.
