[Translated article] SCIWORA in children. A rare clinical entity: Ambispective study.

Area of Science:

• Neurology
• Traumatology
• Epidemiology

Background:

• Spinal Cord Without Radiographic Abnormality (SCIWORA) presents a diagnostic challenge due to its low incidence but significant functional impact.
• Understanding the epidemiology and long-term functional outcomes of SCIWORA is crucial for effective patient management and rehabilitation strategies.

Purpose of the Study:

• To investigate the epidemiological characteristics of SCIWORA.
• To evaluate the functional outcomes of SCIWORA patients with a mean follow-up of 10 years.
• To identify potential correlations between injury mechanisms, imaging findings, and patient demographics.

Main Methods:

• An observational, longitudinal ambispective cohort study was conducted on thirteen SCIWORA patients.
• Data collected included demographics, injury mechanisms, spinal cord MRI findings, and neurological status (ASIA Impairment Scale - AIS).
• Functional outcomes were assessed using the Spinal Cord Independence Measure (SCIM III), and long-term quality of life was evaluated with the Neurogenic Determinants Inventory (NDI), Oswestry Disability Index, and Spinal Cord Injury Quality of Life Index (SV-QLI/SCI).

Main Results:

• The study population comprised mostly men (77%) with a median age of 4 years; 54% of injuries affected the cervical spine.
• Motor vehicle accidents were the most common cause (77%). Initial neurological status was predominantly AIS grade A or C (31% each).
• Patients showed functional improvement from SCIM III scores of 28.5 at admission to 42 at discharge. Long-term assessments indicated moderate disability (NDI: 11.6, Oswestry: 15.3, SV-QLI/SCI: 17).

Conclusions:

• SCIWORA disproportionately affects individuals under 8 years old and young men, with motor vehicle accidents being a primary cause.
• A significant portion of patients (31%) demonstrated neurological improvement to AIS grade D within one year post-discharge, a status maintained at five years.
• No statistically significant associations were found between injury mechanisms and MRI findings, or between age and MRI findings in SCIWORA patients.