Congenital craniocervical anomalies pose a vulnerability to spinal cord injury without radiographic abnormality (SCIWORA)

Abstract

Though the incidence of cervical spine injuries in the pediatric population is relatively low at 1.2% of trauma patients, these injuries are often associated with severe neurologic deficits [1]. Upper cervical spine injuries are more common in children less than 11 years old [1–3]. This may be explained by the unique biomechanics of the pediatric cervical spine [4] as well as the anatomy [3, 5–8]. Furthermore, the craniocervical junction (CCJ) has a dynamic complex anatomic relationship between the occiput and the atlantoaxial structures. Congenitally anomalous CCJ can lead to an acute or chronic disability related to spinal cord compression [1, 9]. Most anomalies of the CCJ are asymptomatic and occult without the presence of an underlying syndrome that may herald its presence such as Klippel-Feil, Goldenhar syndrome, or numerous additional skeletal dysplasias [10]. We present a case of spinal cord injury without radiographic abnormality (SCIWORA) secondary to minor trauma in a pediatric patient with a congenital left atlanto-occipital assimilation joint.