Spinal cord injury without radiographic abnormality (SCIWORA)

SCIWORA is a widely recognized form of spinal cord injury, occurring almost exclusively in children, and is characterized by the absence of any radiographically evident fracture, dislocation, or malalignment. Children presenting with a history of transient neurological signs or symptoms referable to the spinal cord after a traumatic event, despite the absence of objective neurological deficits with normal radiographs, may develop SCIWORA in a delayed fashion. No child with SCIWORA has developed pathological intersegmental motion with instability when early flexion and extension radiographs have been normal. MRI has not identified any abnormal findings in a child with SCIWORA when the management scheme would be changed by the results of the MRI. Similarly, no child with SCIWORA in whom a subsequent MRI has documented ligamentous injury has developed evidence of spinal instability. Treatment consisting of cervicothoracic bracing for patients with cervical-level SCIWORA for 12 weeks and avoidance of activities that encourage flexion and extension of the neck for an additional 12weeks has not been associated with recurrent injury. Patients with normal MRI and SSEP findings following transient deficits or "symptoms only" may be managed with a cervical collar for 1 to 2 weeks. The spinal cord findings on MRI provide prognostic information regarding long-term neurological outcome in patients with SCIWORA. Myelography and angiography have no defined role in the evaluation of children with SCIWORA.