SCIWORA in children. A rare clinical entity: Ambispective study

Area of Science:

• Neurology
• Orthopedics
• Trauma Surgery

Background:

• Spinal cord injury without radiographic abnormality (SCIWORA) presents a diagnostic challenge due to its low incidence but significant functional impact.
• Understanding the epidemiology and long-term outcomes of SCIWORA is crucial for effective patient management.

Purpose of the Study:

• To investigate the epidemiological characteristics of SCIWORA.
• To evaluate the functional outcomes of SCIWORA patients with a long-term follow-up of up to 10 years.

Main Methods:

• An observational, longitudinal ambispective cohort study was conducted.
• Data collected included demographics, injury mechanisms, MRI findings, neurological status (ASIA Impairment Scale - AIS), and functional scores (SCIM III, NDI, Oswestry, SV-QLI/SCI).
• Thirteen SCIWORA patients were analyzed, with re-evaluation in October 2022.

Main Results:

• The median age of SCIWORA patients was 4 years, with 77% being male. Most injuries (54%) were in the cervical spine, primarily from motor vehicle accidents (77%).
• At admission, 31% had AIS grade A and 31% had AIS grade C. Functional scores showed improvement from admission to discharge (SCIM III: 28.5/42).
• Long-term follow-up revealed 31% of patients achieved AIS grade D at 1 year, with this rate remaining constant at 5 years. No significant correlation was found between injury mechanism/MRI findings and age/MRI findings.

Conclusions:

• SCIWORA predominantly affects young children, with a high proportion of cervical spine injuries linked to motor vehicle accidents.
• A significant percentage of patients achieve some degree of functional recovery (AIS grade D) within one year, which is maintained long-term.
• The study highlights the importance of early identification and management of SCIWORA for optimizing functional outcomes in this vulnerable population.