Letter to the Editor: Pediatric Spinal Cord Injury Without Radiographic Abnormality: The Beijing Experience.

Abstract

We read with great interest the article published by Zou et al1 entitled “Pediatric Spinal Cord Injury without Radiographic abnormality: The Beijing Experience." We commend and congratulate the authors’ work on pediatric spinal cord injury without radiographic abnormality (SCIWORA). However, we would like to discuss several potential questions in this study. 1. As far as I know, Zou et al1 reported the largest cases series study about pediatric spinal cord injury without radiographic abnormality. Some children with SCIWORA during follow-up may suffer recurrent SCIWORA as reported by Pang.2 Was there any recurrence of pediatric SCIWORA in these patients? 2. The burden of an SCI in all spheres of life in young children is devastating in consideration of their relatively long life span and immature bodies. Schottler et al3 found that 96% of children with SCI developed scoliosis, 57% had hip dysplasia, 41% developed pressure ulcers, and 61% experienced spasticity. In China, there are many children suffered SCI but without these data, how these children fared in long-term follow-up? 3. The natural recovery and prognosis of SCI in children are more pessimistic than that in adults, especial complete SCI. There was no complete recovery in The American Spinal Injury Association (ASIA) impairment scale (AIS) grade A patients, and there is no improvement of AIS grade in children with complete thoracic SCI.2,4 Fifty percent of the patients had complete impairment (AIS A), and clear neurological improvement was observed in 78% of the patients who was evaluated just before discharge. We suggest that those data need detailed description and list. 4. Some initial magnetic resonance imaging (MRI) may not show serious defects; however, the follow-up MRI may show a more serious abnormality. Serial scans may detect dynamic intramedullary and extramedullary pathological changes or previously undetected abnormalities, which allow clinicians to better provide the appropriate treatment in order to significantly improve the outcome.5 Pathological characteristics of SCI, mostly cord edema and hemorrhage, were detected in 96% of SCIWORA patients by MRI. We agree with authors’ view of the importance of performing MRI. How about the intramedullary lesion length in different AIS grade? This is one important imaging parameter.