Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) is a potentially serious neurologic disorder that can be easily overlooked.
Mechanism: The pediatric bony cervical and thoracic spine may show ligamentous laxity and hypermobility. Traumatic forces on the spinal cord may cause ischemic injury, hyperextension, flexion or longitudinal distraction. A patient with a defect in connective tissue might also be at risk.
Clinical and radiological features:
(1) The patient is usually a pediatric patient, often a child less than 8 years of age.
(2) The patient has had a traumatic event that may affect the spinal cord, usually the cervical region.
(3) Radiographs are negative for fracture, dislocation or malalignment.
(4) The patient may have neurological signs or symptoms referrable to the spinal cord. Initially there may be transient paresthesia, numbness or paralysis followed by paralysis some time later.
(5) MRI may provide prognostic information and should involve the entire spinal column.
(6) Incipient instability of the spine should be excluded by tomography and dynamic flexion-extension films.
(7) Instability should be managed by cervical collar, Halo fixation or surgical fusion. External immobilization is recommended up to 12 weeks.
(8) High risk activities should be avoided for up to 6 months.
Neither angiography nor myelography are indicated.
