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Pediatric Spinal Cord Injury without Radiographic Abnormality: The Beijing Experience
Zhewei Zou1, Anna Teng2, Liuyi Huang2
1Department of Neurology, Beijing Children's Hospital - 56 Nanlishi Road, Xicheng, Beijing, 100045, China.
Insights
Spinal cord injury without radiographic abnormality (SCIWORA) in children is common in China, with sports injuries being a leading cause. Neurological improvement occurred in most patients, but better treatment strategies are needed.
Area of Science:
- Pediatric neurology
- Spinal cord injury research
- Epidemiology of traumatic injuries
Background:
- Spinal cord injury without radiographic abnormality (SCIWORA) predominantly affects children due to unique spinal biomechanics.
- Mainland China has a high incidence of SCI, yet pediatric SCIWORA remains understudied.
- This study addresses the gap by describing the epidemiology and clinical outcomes of pediatric SCIWORA in China.
Purpose of the Study:
- To characterize the epidemiology of pediatric SCIWORA in mainland China.
- To analyze the clinical outcomes and injury patterns in this population.
- To provide foundational data for future research and treatment strategies.
Main Methods:
- Retrospective analysis of pediatric SCIWORA cases at Beijing Children's Hospital from July 2007 to December 2019.
- Inclusion criteria: pediatric patients diagnosed with SCIWORA.
- Data collected included demographics, injury mechanisms, lesion levels, imaging findings (MRI), neurological status (AIS), and treatment outcomes.
Main Results:
- 140 pediatric SCIWORA cases identified, with a mean age of 5.65 years and a 2:5 male-to-female ratio.
- Sports-related injuries (41%), particularly backbends, were the most common cause, followed by falls (27%).
- Thoracic lesions were most frequent (77%), and 96% showed abnormalities on MRI; 50% had complete SCI (AIS A). Neurological improvement was observed in 59 of 76 patients.
Conclusions:
- Significant demographic and clinical variations exist in pediatric SCIWORA.
- Combined MRI and thorough neurological examination are crucial for accurate diagnosis.
- Further research is warranted to develop optimized treatment protocols for pediatric SCIWORA.
Study Design:
Retrospective study.
Objective:
To describe the epidemiology and clinical outcomes of pediatric patients with spinal cord injury (SCI) without radiographic abnormality (SCIWORA) in mainland China for the first time.
Summary Of Background Data:
SCIWORA is a syndrome that often occurs in children mainly due to the unique biomechanics of the pediatric spine. Although there have been numerous retrospective studies on pediatric SCIWORA, and mainland China has more patients with SCI than anywhere else, pediatric patients with SCIWORA in mainland China has not been described in any study.
Methods:
Review of all cases with SCIWORA at Beijing Children's Hospital between July 2007 and December 2019.
Results:
Of the 189 pediatric patients with SCI 140 had SCIWORA (age: 5.65 ± 2.60 years, male-to-female ratio: 2:5). Main causes of injuries were sports (41%, mostly backbend), falls (27%), traffic accidents (10%), and violence (8%). Lesions were located at the thoracic (77%), cervical (10%), multiple (5%), and lumbar (4%) levels. Incubation period was 2 ± 6 hours. Pathological characteristics of SCI were detected in 96% patients by magnetic resonance imaging (MRI). Based on the American Spinal Injury Association impairment scale (AIS), many patients had complete impairment (50% AIS A, 45% AIS B/C/D, 1% AIS E). Particularly, the five patients with normal MRI tended to have mild injury (AIS D) (P < 0.001), but they still showed abnormal reflex. In the one patient who could not be graded at all by AIS, his only functional deficits were abnormal upper and lower limb muscle tones. A total of 59% patients were treated with methylprednisolone, dexamethasone, or both. Out of 76 patients 59 showed neurological improvement before discharge. The only association among age, cause of injury, level of lesion, incubation period, AIS grade, type of corticosteroid therapy, and neurological improvement was between level of lesion and AIS grade (P < 0.001).
Conclusion:
Demographic and clinical differences exist in patients with SCIWORA. MRI and detailed neurological examinations should both be performed for proper diagnosis. There is still a need to develop better treatment strategy for these patients.Level of Evidence: 4.
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