Spinal cord injury without radiographic abnormality

Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) is a medical condition primarily observed in children and adolescents, where damage to the spinal cord occurs without any evidence of injury to the vertebral column on radiographs or computed tomography (CT) scans.

Definition

SCIWORA is defined as clinical evidence of injury to the spinal cord without corresponding radiographic or CT abnormalities. The term was first coined in 1982 by Pang and Wilberger. It is most commonly seen in children under the age of 8, due to the flexibility of their vertebral column and the relative mobility of the spinal cord within the spinal canal.

Epidemiology

SCIWORA accounts for approximately 15-20% of all pediatric spinal injuries. The incidence is higher in children due to the elasticity of their spine, which allows for more movement of the spinal cord within the spinal canal during trauma.

Pathophysiology

The exact mechanism of injury in SCIWORA is not well understood. It is believed that the injury occurs due to the stretching or compression of the spinal cord during traumatic events. This can lead to neuropraxia, a temporary loss of motor and sensory function due to blockage of nerve conduction, or more severe damage including axonal injury or ischemia.

Clinical Presentation

Patients with SCIWORA may present with a wide range of symptoms, from mild sensory changes to complete paralysis. Symptoms may not appear immediately after the injury and can develop over a period of hours to days.

Diagnosis

Diagnosis of SCIWORA is primarily clinical, based on the patient's history and physical examination. Imaging studies, including magnetic resonance imaging (MRI), may be used to confirm the diagnosis and assess the extent of the injury.

Treatment

The treatment of SCIWORA is primarily supportive, focusing on the management of symptoms and prevention of further injury. This may include immobilization of the spine, physical therapy, and in some cases, surgery.

Prognosis

The prognosis of SCIWORA varies widely, depending on the severity of the initial injury and the patient's response to treatment. Some patients may recover completely, while others may have long-term neurological deficits.