A study of Spinal Cord Injury without Radiographic Abnormalities in Children

Abstract

Background: “Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. Aim and Objective: This study was carried out to analyze the incidence, clinical features, diagnosis, including MRI features, and therapeutic approaches. Material and Method: Out of seventy cases of spinal injury below 12 years of age admitted in the emergency neurosurgery ward of  Rani Durgawati Medical college, Banda between December 2022 and December 2023, 15 patients diagnosed with SCIWORA were included in this study. The patients were assessed for mechanism of injury, radiographic assessment by X-ray of the spine in all patients, and a CT scan in some patients. All patients underwent an MRI. Observation and Result: Clinical assessment of patients was done using the ASIA impairment scale at the time of admission, discharge, and follow-up at a 3-month and 6-month interval. The majority of patients were below 4-8 years of age (46.67%). Fall was the most common mode of injury, and the cervical spine was the most common site of injury. The majority of patients had an abnormality on the MRI. Conclusion: SCIWORA is relatively common in pediatric patients with spinal injuries, and early treatment is associated with a good outcome. MRI is helpful in predicting the outcome.