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Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations
Nikolay Konovalov1, Nikolay Peev2, Mehmet Zileli3
1Burdenko Institute Department of Neurosurgery, Moscow, Russian Federation.
Insights
Pediatric cervical trauma and Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) management requires standardized protocols. Non-surgical treatment with immobilization is the mainstay for SCIWORA, with prognosis tied to initial neurological status.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Trauma Management
Background:
- Pediatric cervical trauma differs anatomically from adults, necessitating specific management strategies.
- Current protocols for pediatric cervical trauma and Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) lack standardization.
Purpose of the Study:
- To review current diagnostic and treatment options for pediatric cervical trauma and SCIWORA.
- To establish consensus statements on managing these conditions.
Main Methods:
- Literature search of the past 10 years, excluding case reports, experimental studies, and non-English papers.
- Consensus meetings utilizing the Delphi method to vote on statements regarding pediatric cervical trauma and SCIWORA.
Main Results:
- Non-surgical treatment, including immobilization and activity avoidance, is the primary approach for SCIWORA.
- Prognosis for SCIWORA is influenced by initial neurological status and MRI findings.
Conclusions:
- Significant discrepancies in the literature highlight the need for standardized protocols in pediatric cervical trauma and SCIWORA.
- Future randomized controlled trials are essential to develop evidence-based guidelines.
Abstract:
Cervical trauma in children have variations from the adults mainly due to anatomic differences. An optimal diagnostic and treatment strategy is critical, particularly when there is a lack of standardized protocols for the management of such cases. This review paper examines the diagnostic and treatment options of pediatric cervical trauma and Spinal Cord Injury Without Radiographic Abnormality (SCIWORA). A literature search for the last 10 years were conducted using key words. Case reports, experimental studies, papers other than English language were excluded. Up-to-date information on pediatric cervical trauma and SCIWORA were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of WFNS Spine Committee. The statements were voted and reached a consensus using Delphi method. This review reflects different aspects of contemporary pediatric cervical trauma decision-making and treatment, and SCIWORA. The mainstay of SCIWORA treatment is nonsurgical with immobilization, avoidance of risky activities. Prognosis generally depends on the initial neurological status and magnetic resonance imaging. Due to a significant discrepancy in the literature on diagnostic and management, future randomized controlled trials are needed to aid in generating standardized protocols.
