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SCIWORA (spinal cord injury without radiographic abnormality) in infants and children
1Department of Diagnostic Radiology, University of Kentucky Medical Center, Lexington 40536-0084, USA.
Insights
Pediatric cervical spine injuries, known as spinal cord injury without radiographic abnormality (SCIWORA), occur due to unique spinal hypermobility. This allows cord damage without bone fractures, often from hyperextension or distraction injuries.
Area of Science:
- Pediatric orthopedics
- Neurology
- Biomechanics
Background:
- Pediatric cervical spine injuries present unique challenges in diagnosis and management.
- Spinal cord injury without radiographic abnormality (SCIWORA) is a significant cause of neurologic deficits in children.
- Understanding the biomechanical factors is crucial for identifying at-risk populations.
Purpose of the Study:
- To review the biomechanics of the pediatric cervical spine.
- To correlate clinical findings with SCIWORA.
- To enhance understanding of this pediatric trauma phenomenon.
Main Methods:
- Literature review focusing on pediatric cervical spine biomechanics.
- Analysis of clinical findings associated with SCIWORA.
- Synthesis of data on closed spinal trauma mechanisms in children.
Main Results:
- The pediatric cervical and thoracic spine's hypermobility and ligamentous laxity predispose children to SCIWORA.
- The spine's elasticity allows extreme deformation, causing cord trauma followed by spontaneous reduction.
- Mechanisms include hyperextension/flexion, longitudinal distraction, and ischemic injury.
Conclusions:
- Pediatric spinal biomechanics play a critical role in SCIWORA development.
- SCIWORA represents a distinct pattern of pediatric spinal trauma with severe neurologic consequences.
- Further research into prevention and treatment strategies is warranted.
Abstract:
We review the biomechanics of the pediatric cervical spine and the clinical findings that pertain to SCIWORA (spinal cord injury without radiographic abnormality) in order to provide a more thorough understanding of this pediatric phenomenon of closed spinal trauma with significant neurologic sequelae but without bony injury. The unique hypermobility and ligamentous laxity of the pediatric bony cervical and thoracic spine predispose to a SCIWORA-type injury. In SCIWORA, the unusually elastic biomechanics of the pediatric bony spine allow deformation of the musculoskeletal structures beyond physiologic extremes, permitting direct cord trauma followed by spontaneous reduction of the bony spine. Potential mechanisms of the SCIWORA include hyperextension/flexion, longitudinal distraction, and ischemic injury of the spinal cord.