Spinal Cord Injury In Children Research Articles

Advance in pediatric spinal cord injury

AbstractThe incidence rate of spinal cord injury in children is lower than that in adults, accounting for about 5% of all spinal cord injuries. Motor vehicle accidents are the main cause of spinal cord injuries in children. As the spine of children is still in the process of growth and development, the anatomical structure and biomechanics have unique characteristics, and its etiology, injury site, and clinical manifestations are different from those of adults. Misdiagnosis and delayed diagnosis can lead to severe spinal deformity and neurological complications. Children and adolescents with spinal cord injuries may suffer from lifelong disability, which will do great harm to children, families, and society. Early magnetic resonance imaging examination can effectively avoid underdiagnosis of spinal cord injury without radiographic abnormality and select appropriate treatment. In addition, it is also important to establish a family‐centered rehabilitation model to help the affected children reintegrate into society and achieve the goal of returning to normal life. This article reviews the etiology, epidemiology, clinical characteristics, complications, and treatment of spinal cord injury in children and adolescents.

Traumatic Spinal Cord Injury in Children: Clinical Profile and Management Outcome in a Developing Country's Rural Neurosurgery Practice.

There is paucity of data-driven study on pediatric traumatic spinal cord injury (SCI) in the developing countries. This study aims to define the clinical profile of pediatric traumatic SCI in a rural tertiary hospital in a sub-Saharan African country. This was a prospective observational study of all children with spinal cord injury managed at our center over a 42-month period. There were 20 patients, comprising 13 males and 7 females with a mean age of 11.5 years. Road traffic crash was the cause in 70% of the cases (motorcycle accident = 45%), and fall from height in 25%. Pedestrians were the victims of the road traffic crash in 42.9% (6/14) of the cases, while 21.4% (3/14) and 28.6% (4/14) were passengers on motorcycles and in motor vehicles, respectively. The cervical spine was the most common location of injury, occurring in 90% of the cases (18/20). Seventy-five percent of the patients (15/20) had transient deficits, but were grossly normal neurologically on examination (American Spinal Cord Injury Association [ASIA] grade E); 2 patients had ASIA D, while 1 patient each had ASIA C, B, and A injuries. All patients were managed nonoperatively. The patients with incomplete deficits improved, while those with complete injury did not make any motor or sensory gain. Road traffic accident, mostly motorcycle crash, was the most common etiology of pediatric SCI in this series, and most of the injuries were located in the cervical spine. Disabling injury constituted a small proportion of pediatric SCI in our practice.

The classification of consequences and complications of spinal cord injury in children

BACKGROUND: Consequences and complications of spinal cord injury in children which appear at all recovery stages significantly affect outcomes. The Classification proposed in 1994 does not provide a clear distinction between terms "consequences" and "complications" and currently, in our opinion, is outdated and was outdated long ago, since it raises more questions than it contains answers.
 AIM: to propose a new classification of spinal cord injury consequences and complications in children covering all periods of the injury course.
 MATERIAL AND METHODS: Children with severe spinal and spinal cord injury who have been admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in Moscow since 2014 were taken into the study. To diagnose their current state, the following diagnostic tools were used: clinical examination, trophological status, neurological assessment by ASIA scale, locomotor pattern, laboratory and instrumental testings; in addition, psychological examination so as to identify child's post-traumatic disadaptation and psychopathological state.
 RESULTS: Three years after the injury, spinal cord injury consequences were detected in 96% of injured children; spinal cord injury complications ― in 56% of children who were treated at Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in 20142020. The authors have developed a new classification of spinal cord injury consequences and complications in children.
 CONCLUSION: The early start of rehabilitation measures and subsequent long-term medical and psychological support of children with spinal cord injury delays the onset of spinal cord injury consequences, prevents complications, as well as encourages the child and his/her parents to comply with the recommendations of the rehabilitation team. Underestimation of the severity of child's condition can lead not only to the deprivation of motor restoration, but also to the deterioration in the quality of family life and to the problem of integrating children with spinal cord injury into the society.
 The newly developed classification is an important instrument to improve injury outcomes, child's growthand development as well his/her integration into the social environment.

Prognosis of traumatic spinal cord injury in children: Follow-up of 86 patients

PurposeThe long-term situation of children with spinal cord injury (SCI) was investigated, and suggestions for helping them better return to the society were provided. MethodsSCI patients less than 18 years old hospitalized in Beijing Boai Hospital from January 2011 to December 2020 were retrospectively analyzed. Information including motor function, complications, characteristic changes, self-care abilities, school attendance and social participation were collected by telephone interview and electronic questionnaire. All the answers were statistically analyzed. ResultsA total of 86 cases were enrolled, 77 girls and 9 boys, with a median injury age of 6 years and 2 months. The follow-up time was 3–130 months. The main cause of trauma in these children was sport injury (66.3%), the thoracic spinal cord was involved the most (91.9%), and complete SCIs accounted for the majority (76.7%). In terms of complications, children with complete SCIs were more likely to have urinary incontinence, constipation and characteristic changes (p < 0.05); whereas the incomplete SCIs often have spasticity (p < 0.05). As to the daily living abilities, children with incomplete lumbar SCIs were more capable to accomplish personal hygiene, transfer, and bathing independently than those with complete injuries, or cervical/thoracic SCIs, respectively (p < 0.05). Moreover, children older than 9 years care more able to dress and transfer independently than the youngers (p < 0.05). Wheelchair users accounted for 84.9% and more than half of them were able to propel wheelchair independently, and those who move passively in wheelchairs were mostly introverted kids (p < 0.05). Almost all (93.8%) children with incomplete injuries were able to walk independently. Most (79.1%) children continued to attending school, and 41.9% participated in interest classes. Unfortunately, 67.4% of the children spent less time playing with their peers than before the injury. ConclusionSCIs impair physical structures and function of children, affect their independence in daily living, and restrict school attendance and social interaction. Comprehensive rehabilitation after injury is a systematic work. Medical staff and caregivers should not only pay attention to neurological function, but also help them improve self-care abilities. It is also important to balance rehabilitation training and school work and social participation.

Clinical characteristics and treatment of spinal cord injury in children and adolescents

Pediatric and adult spinal cord injuries (SCI) are distinct entities. Children and adolescents with SCI must suffer from lifelong disabilities, which is a heavy burden on patients, their families and the society. There are differences in Chinese and foreign literature reports on the incidence, injury mechanism and prognosis of SCI in children and adolescents. In addition to traumatic injuries such as car accidents and falls, the proportion of sports injuries is increasing. The most common sports injury is the backbend during dance practice. Compared with adults, children and adolescents are considered to have a greater potential for neurological improvement. The pathogenesis and treatment of pediatric SCI remains unclear. The mainstream view is that the mechanism of nerve damage in pediatric SCI include flexion, hyperextension, longitudinal distraction and ischemia. We also discuss the advantages and disadvantages of drugs such as methylprednisolone in the treatment of pediatric SCI and the indications and timing of surgery. In addition, the complications of pediatric SCI are also worthy of attention. New imaging techniques such as diffusion tensor imaging and diffusion tensor tractography may be used for diagnosis and assessment of prognosis. This article reviews the epidemiology, pathogenesis, imaging, clinical characteristics, treatment and complications of SCI in children and adolescents. Although current treatment cannot completely restore neurological function, patient quality of life can be enhanced. Continued developments and advances in the research of SCI may eventually provide a cure for children and adolescents with this kind of injury.

DTI of chronic spinal cord injury in children without MRI abnormalities (SCIWOMR) and with pathology on MRI and comparison to severity of motor impairment

This investigation was a cohort study that included: 36 typically developing (TD) children and 19 children with spinal cord lesions who underwent spinal cord MRI. To investigate diffusion tensor imaging (DTI) cervical and thoracic spinal cord changes in pediatric patients that have clinically traumatic and non-traumatic spinal cord injury (SCI) without MR (SCIWOMR) abnormalities. Thomas Jefferson University, Temple University, Shriners Hospitals for Children all in Philadelphia, USA. 36 TD children and 19 children with spinal cord lesions that represent either a chronic traumatic acquired SCI or chronic non-traumatic SCI (≥6 months post injury), age range, 6-16 years who underwent cervical and thoracic spinal cord MRI in 2014-2017. Additionally DTI was correlated to clinical American Spinal Injury Association Impairment Scale (AIS). Both SCIWOMR and MRI positive (+) groups showed abnormal FA and RD DTI values in the adjacent MRI-normal appearing segments of cephalad and caudal spinal cord compared to TD. The FA values demonstrated perilesional abnormal DTI findings in the middle and proximal segments of the cephalad and caudal cord in the SCIWOMR AIS A/B group compared to SCIWOMR AIS C/D group. We found DTI changes in children with SCIWOMR with different causes of spinal lesions. We also investigated the relationship between DTI and clinical AIS scores. This study further examined the potential diagnostic value of DTI and should be translatable to adults with spinal cord lesions.

Isolated spinal cord injury in children - SCIWORA syndrome

Isolated spinal cord injury in children - SCIWORA syndrome

Traumatic brain injury of childhood

Traumatic brain injury of childhood

Diagnostic Errors of Spinal Cord Injuries in Children with Combined Trauma on the example of Clinical Cases

Diagnostic errors of spinal cord injuries with combined trauma in children are facilitated by the patient’s age, which does not allow foran adequate neurological assessment of motor and sensitive disorders, a reduced state of consciousness in severe traumatic brain injury,the lack of modern methods of neuroimaging in primary hospitals, insufficient qualifications and experience of medical personnel. Aim. To demonstrate outcomes of diagnostic errors in traumatic spinal cord injury in children on clinical examples of two patients. Material and methods. The object of observation was children with severe combined trauma, whose post-traumatic spinal cord injurywas missed in the primary hospital. To diagnose the current condition, the following were used: clinical examination with a neurologicalassessment on the ASIA scale, assessment of motor functioning, laboratory monitoring, instrumental examination, ultrasoundmonitoring, X-ray, MRI, CT, CT densitometry, ECG, echocardiography, USDG. In addition, neuropsychological assessment was made so to evaluate cortical functions and to reveal consequences of traumatic brain injury. Results. The cause of errors in the diagnostics of spinal cord injury in children is the underestimation of state severity due to the combinedtype of injury or small age of the child. Conclusion. The experience of the multidisciplinary team of specialists in the diagnosis and medical rehabilitation of children withspinal cord injury missed in the primary hospital indicates the need to conduct a full-fledged neurological examination, CT accordingto the “head to toe” program and MRI, even if there is a slight suspicion of the spinal cord damage.Underestimation of the severity of the child’s condition with concomitant trauma, including spinal cord injury, leads to the deprivationnot only in the motor function restoration, but also to deterioration in the quality of life of the family and to the problems associatedwith patient’s integration into society.

Errors in the Diagnosis of Spinal Cord Isolated Injury in Children

One of the features of traumatic spinal cord injury in children is a high probability of the isloted form of its injury (syndrome SCIWORA – spinal cord injury without radiograph abnormality). Mobility and elasticity of the spine column in childhood explains a relatively rare incidence of its injury in young children; however, we meet a high incidence of the isolated spinal trauma in this group of patients. According to various authors, SCIWORA is more common in children under the age of 5 ~ 64%; from 6 to 12 ~ 35%; over 12 – about 20%. The relevance of the present study is explained by errors in the isolated spinal cord injury diagnostics and by the lack of clear clinical and diagnostic algorithm optimizing SCIWORA verification in this category of patients. Aim. To analyze the level of SCIWORA diagnostics in children with spinal cord injury (SCI) in a specialized surgical hospital as well as to assess reasons of misdiagnostics. Material and methods. 167 children with SCI were included into the study. They were admitted to the Clinical and Research Institute of Emergency pediatric Surgery and trauma (CRIEpSt) in 2014-2020. Depending on the time of admission, patients were divided into two groups: Group I – children who were admitted to the hospital within the first month after injury; Group II – children who were admitted later. Children aged 12.2 ± 5.0 y.o., in average. All patients were examined for their neurological status by ASIA scale; they also had radial diagnostics: computed tomography (CT) and magnetic resonance imaging (MRI). Results. The isolated spinal cord injury (SCIWORA) was revealed in 6.0% of children with SCI who were admitted to CRIEpSt in 2014 – 2020. The greater number of SCIWORA (60%) occurred as a result of road accidents and was recorded in the thoracic region (50%). Isolated the soinal cord injury occured more often in the age groups under 5 y. o. and 5 – 12 y.o. (by 40% in each age group). The severity of spinal cord injury in SCIWORA depends on the very mechanism of such damage: A – 80%, B – 20% by ASIA scale. In SCIWORA, computed tomography does not allow to fully assess SCI severity. MRI is prescribed for more precise diagnostics: to clearly visualize damages to the ligamentous apparatus and intervertebral discs; in addition to clinical findings to confirm contusion, hematomyelia, partial or complete rupture of the spinal cord; to make rehabilitation prognosis using tractography. Conclusion. The reasons for errors in the isolated spinal cord injury diagnosis in children is a result of underestimated severity of child’s condition due to his/her young age or due to the combination of SCI with severe traumatic brain injury (TBI) with a reduced state of consciousness. In case of even a slight suspicion of isolated spinal cord injury, the diagnostic algorithm in little children or in patients with reduced consciousness state should include a “head-to-toe” CT scanning and MRI examination in addition to a full-fledged neurological examination.

Multicenter study of 37 pediatric patients with SCIWORA or other spinal cord injury without associated bone lesion

BackgroundPure traumatic spinal cord injury (without associated bone lesion) are encountered in pediatric accidentology, the most typical being spinal cord injury without radiological abnormality (SCIWORA). The present study reports a multicenter series of under-18-year-olds admitted for traumatic medullary lesion. The objectives were: (1) to describe the causes of pure spinal cord injuries in children in France and their clinical presentation; (2) to identify any prognostic factors; and (3) to describe their medical management in France. Patients and methodA multicenter retrospective study was conducted in 3 pediatric spine pathology reference centers. Files of 37 patients with confirmed spinal cord injury between January 1988 and June 2017 were analyzed: SCIWORA (n=30), myelopathy associated with severe cranial trauma (n=2), and obstetric trauma (n=5). Accident causes, associated lesions, initial Frankel grade, level of clinical spinal cord injury, initial MRI findings, type of treatment and neurology results at last follow-up were collated. The main endpoint was neurologic recovery, defined by improvement of at least 1 Frankel grade. ResultsCauses comprised 17 road accidents, 11 sports accidents, 5 obstetric lesions and 4 falls. Mean follow-up was 502 days. The rate of at least partial neurologic recovery was 20/30 in SCIWORA, 0/5 in obstetric trauma, and 0/4 in case of associated intracranial lesion. In SCIWORA, factors associated with recovery comprised age, accident type, and absence of initial MRI lesion. DiscussionWe report a large series of pediatric spinal cord injury without associated bone lesion. This is a potentially serious pathology, in which prognosis is mainly related to age and trauma mechanism. Level of evidenceIV, case series.

Comparative evaluation of desflurane and sevoflurane anesthesia during surgical correction of vertebral and spinal cord injury in children

Introduction. Currently, inhaled third-generation anesthetic agents, such as sevoflurane and desflurane, are commonly used in pediatric practice. Their properties and efficiencies are studied in detail. Information about the effectiveness and safety of these drugs as emergency anesthesia in children is very limited; there are no comparative studies. The aim of this study was to conduct a comparative evaluation of desflurane and sevoflurane to maintain anesthesia during the surgical correction of vertebral and spinal cord injury in children.&#x0D; Material and methods. This study included seventy-four 12–18-year-old patients (mean age, 14 years) who underwent immediate surgical correction of unstable fractures of the thoracolumbar and lumbar spine at the Turner Scientific Research Institute for Children’s Orthopedics between 2015 and 2017. The patients were categorized into two groups: group D, in which anesthesia was maintained with desflurane (35 patients), and group C, in which anesthesia was maintained with sevoflurane (39 patients). The following parameters were studied: systolic, diastolic, and average blood pressure (BP); heart rate (HR); respiratory recovery time; time to extubation; time to instruction completion; and presence of complications intraoperatively and within 24 h after surgery, including pronounced intraoperative hypotension, bradypnea, and desaturation (SpO2 &lt; 95%) in the postextubation period, agitation, nausea, vomiting, and measured blood loss.&#x0D; Results. A comparative evaluation of the investigated parameters revealed that the systolic, diastolic, and average BP and HR in both groups did not exceed the limits of acceptable values. The results of the intraoperative monitoring of capillary blood parameters in all patients were within the reference range and did not differ significantly between groups. An analysis of the indicators reflecting the rate of awakening revealed that all stages of the termination of anesthesia were performed more quickly in group D. There was a comparable number of postoperative nausea and vomiting episodes in both groups. Group C displayed a high incidence of postoperative agitation. There were no related adverse respiratory effects in group D, whereas three patients reported such effects in group C.&#x0D; Conclusions. The use of desflurane and sevoflurane provides a favorable hemodynamic profile intraoperatively and is not accompanied with the development of clinically significant side effects. Desflurane reduces the probability of certain adverse effects in the immediate postoperative period, provides a faster awakening, and has the possibility of reliable assessment of neurological status after surgery.

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ПОВРЕЖДЕНИЙ ПОЗВОНОЧНИКА У ДЕТЕЙ

Spine injuries in children are of great social significance. Currently, the incidence of spinal cord injuries in children has increased; this is due to the use of modern imaging devices (digital X-ray examination, CT, MR1) at the prehospital and hospital stages. For children, compression fractures of the vertebral body, which are associated with serious injuries to the musculoskeletal system, are more characteristic. Compression fractures of vertebral bodies (1-2 %) with improper treatment can lead to aseptic necrosis of the vertebra, kyphoscoliosis and other pathological conditions, which often results in disability. When X-ray diagnosis of fractures of transverse and spinous processes, one should consider additional ossification points, which can be mistaken for fractures. Also, differential diagnosis should take into account congenital wedge vertebrae and other abnormalities of vertebral development, which can be mistaken for fractures. The publication presents the results of a comprehensive examination and treatment of 85 children with spine trauma. The age of the examined was from 3 months to 16 years. In 20 cases, we detected compression fractures of the spine at different levels (cervical - 1, upper-thoracic - 4, medium-thoracic - 10, lower-thoracic - 2, lumbar - 3). In 25 cases, a rotational subluxation of the C 1 vertebra was diagnosed, in 3 - a traumatic rupture of the intervertebral disc, in 29 - a fracture of the coccyx. Complicated injuries of the spine accompanied by lesions of the spinal cord and roots were noted in 7 patients. Given the anatomical and physiological features of spine injuries in children, conservative methods of treatment were predominantly used.

Epidemiology of traumatic spinal cord injury in childhood and adolescence in Galicia, Spain: report of the last 26-years.

ObjectiveTo analyze the characteristics of traumatic spinal cord injury in children of Galicia (Spain).DesignDescriptive and retrospective study.MethodsData extracted from the internal registry of the Spinal Cord Injury Unit and the patient's medical records, between March 1988 and December 2014. Inclusion criteria: patients aged ≤ 17 years with a traumatic spinal cord injury.Outcome measures: Total patients, percentages, incidence, ASIA scale results and improvement.ResultsA total of 68 patients were included. The incidence was 5.6 cases/1,000,000 inhabitants/year.The mean age was 14.4 years (median: 16). Only 25% were younger than 15. Male patients accounted for 73.5% of the total.The main cause were traffic accidents (60.3%; n = 41), being higher (77.8%) in children ≤ 10 years. Other etiologies included falls (19.1%), diving accidents (16.2%) and other causes (4.4%).Eleven patients (16.2%) had injuries classified as SCIWORA, 8 (72.7%) of them aged ≤ 10 years. The mean age of the SCIWORA group was 7.5 years versus 15.7 years in the non-SCIWORA group (P < 0.001). Half (50%) of these patients had a complete spinal cord injury and, of these, 64.6% were paraplegic.ConclusionsTraumatic spinal cord injuries are rare in children, and most cases occur between 15 and 17 years. Unlike in adults, SCIs in children mostly involve the thoracic spine. Most patients aged ≤ 10 years have SCIWORA. The most common etiology continues to be traffic accidents, although sports accidents prevail among adolescent patients.

The Morphology of the Spinal Cord after Traction Injuries

Actuality. Traction spinal cord injuries in children are of particular interest to researchers at present. Tractional damage associated not only with the trauma (SCIWORA syndrome), but can occur during elimination of deformation of the spine.&#x0D; The purpose of the study was to study the peculiarities of morphological disorders of the spinal cord in traction mechanism of injury. Materials and methods. Performed 3 series of experiments on test machine AL-7 LA10. Dosed stretching of the spine of experimental animals (n=12) varied at 5, 10 and 20% of its original length. After 72 hours animals were removed from the experiment and carried out a histological study of the spinal cord.&#x0D; Results and their discussion. It was found that after traction cyto - and myeloarchitectonic the cord was changed depending on the degree of stretching of the spine. If a strong tension (20%) of the neurons was exposed to irreversible changes. The recovery of the functional modules was probably due to the reorganization of surviving neural networks.&#x0D; Сonclusion. The obtained data can be taken into account when planning the operations to eliminate kyfo-scoliosis spinal deformities in children.

Pediatric Spinal Cord Injury Due to Acute Flaccid Myelitis: Epidemiology, Clinical Management, and Implications for Rehabilitation

Acute flaccid myelitis (AFM) is a recently described rare syndrome causing spinal cord injury in children. The purpose of this review is to describe the epidemiology of AFM, clinical presentation, and management. We further describe outcomes, rehabilitation strategies, and future directions for this group of children. Outbreaks of Enterovirus D-68 (EV D-68) starting in 2014 coincided with increase in acute flaccid paralysis cases in children which were tracked by the Centers for Disease Control and Prevention (CDC). CDC provided guidelines for identification and management of cases of AFM. Long-term follow-up has not been sufficient but children with AFM have a wide range of presentation and residual disability following the illness. Further studies are needed to assess long-term outcomes and to help prevent AFM. The epidemiology and acute management of AFM is well described in the literature but long-term follow-up and outcomes remain needed, especially regarding long-term disability from spinal cord injury. Additional studies are needed to provide further evidence of best practice and possible prevention.

Spine and spinal cord injury in children

Spine and spinal cord injury in children

MECHANISMS OF ISOLATED SPINAL CORD INJURY IN CHILDREN

Objective. To study the mechanisms of spinal cord injury in children of different age groups. Material and Methods . А retrospective analysis of the results of treatment of 217 children aged 1 to 15 years with traumatic injuries of the spine and spinal cord was performed. Group A included patients with spinal cord injury without damage to the spine (n = 139), and Group B - with spinal cord injury accompanied by spinal column injury (n = 78). McAffe сlassification of spinal injury mechanisms was used. Neurological deficit was evaluated according to the Frankel scale. Main causes and mechanisms of these injuries were studied. Results . Principal mechanisms of spinal cord injury in children were as follows: distractive extension and compressive flexion for isolated SCIWORA-type injuries, and compressive flexion for the spine and spinal cord injuries. Conclusion . The most pronounced neurological deficit is observed after exposure to compression-flexion mechanism of injury. Traction mechanisms of injury cause severe neurological disorders peculiar to SCIWORA syndrome.

Cervical fractures with associated spinal cord injury in children and adolescents: epidemiology, costs, and in-hospital mortality rates in 4418 patients.

BackgroundCervical spine fractures with spinal cord injury (CFSCI) can be devastating. We describe the epidemiology of children and adolescents with CFSCI.MethodsUsing the Nationwide Inpatient Sample (NIS) database, we identified 4418 patients (≤18 years old) who had CFSCI from 2000 through 2010. Outcomes of interest were patient characteristics (age, sex), injury characteristics [fracture location, spinal cord injury (SCI) pattern], economic variables (duration of hospital stay, total hospital charges), and mortality.ResultsUpper cervical fractures (UCFs) occurred half as often (31.4 %) as lower cervical fractures (LCFs; 68.8 %). Among patients <8 years old, 73.6 % had UCFs; among patients ≥8 years old, 72.3 % had LCFs. Overall, 68.7 % had incomplete SCI, 22.4 % had complete SCI, 6.6 % had central cord syndrome, and 2.3 % had anterior cord syndrome. Patients with complete SCI had the longest hospital stays and highest hospital charges. The overall in-hospital mortality rate was 7.3 %, with a sixfold higher rate in patients <8 (30.6 %) vs. those ≥8 (5.1 %) years old (p < 0.001). There was a threefold higher mortality rate in patients with upper (13.5 %) vs. lower (4.3 %) cervical fractures (p < 0.001). Patients with complete SCI had a 1.85-fold higher mortality rate than patients with other cord syndromes (p < 0.001).ConclusionsPatients <8 years old were more likely than older patients to sustain UCFs. Patients with UCFs had a significantly higher mortality rate than those with LCFs. Patients with complete SCI had the longest duration of hospital stay and highest hospital charges and in-hospital mortality rate.

Spinal cord injury without radiologic abnormality in children: a systematic review and meta-analysis.

Spinal cord injury in children is associated with severe morbidity and immense socioeconomic burden. In spinal cord injury without radiologic abnormalities (SCIWORA), magnetic resonance imaging (MRI) can detect intramedullary or extramedullary pathologies or show absence of neuroimaging abnormalities. However, the prognostic and therapeutic consequences of specific MRI patterns are unclear. A comprehensive systematic literature search was performed to examine patient characteristics and imaging patterns of pediatric SCIWORA and to evaluate the prognostic value of a MRI-based classification system. MEDLINE, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for studies on SCIWORA in children. Inclusion criteria were (1) traumatic spinal cord injury with acute neurologic deficit, (2) absence of fractures and/or dislocations of the spine, and (3) an immature skeleton or age of less than 18 years. MRI patterns and clinical course were correlated. Forty articles reporting 114 patients were identified. At admission, neurologic deficit assessed by the American Spinal Injury Association impairment scale was A in 28%, B in 17%, C in 31%, and D in 25%. At final follow-up, these were 19%, 6%, 10%, and 16%, respectively. In 43%, no MRI abnormalities (Type I) were detected, and 57% exhibited abnormal scan results (Type II): 6% revealed extraneural (Type IIa), 38% intraneural (Type IIb), and 13% combined abnormalities (Type IIc). At admission and follow-up, American Spinal Injury Association impairment scale differed significantly between the imaging types. This systematic review emphasizes the prognostic value of spinal MRI for children with SCIWORA. It highlights the role of the MRI classification system in improving the comparability and interpretability. Systematic review, level IV.