Page 18 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Spinal cord injury without radiological abnormalities

children. When children engage in repetitive backbend A B
movements, dynamic compression of the spinal vessel,
and longitudinal traction of the spine during sustained or
repeated hyperextension play critical roles in the onset of
SCIWORA. Magnetic resonance imaging (MRI) serves as
the gold standard for diagnosis and prognosis evaluation,
although it may initially show a normal appearance.
In addition, the symptoms of SCIWORA can exhibit
delayed onset, and there is a possibility of recurrence [4,5] .
Education and awareness are imperative for accurate
diagnosis, treatment, prevention, and mitigation of further
neurological function deterioration. Timely management
of SCIWORA is essential to prevent secondary injury.
At the same time, treatment decisions and management
should be tailored on a case-by-case basis . This article
[6]
aims to provide essential insights into SCIWORA in Figure 1. Backbend movement. (A) Children’s hyperextension and spine
children, assisting practitioners in achieving precise shape; (B) spinal cord injury at T9 – T10, involving transient slippage of
the apical vertebral body and facet joints, lateral compression injury of the
diagnoses and significant prognoses. spinal cord by the anterior and posterior ligaments, excessive longitudinal
traction injury concentrated at the junction of the cauda equina and
2. MOI conus (similar to the different mechanics of the tendon-muscle body),
and interfacial stretch injury.
The pediatric spine exhibits significant differences from the
adult spine, rendering the spinal cord susceptible to injury or repeated hyperextension of the spine is believed to be
due to factors such as flexion, hyperextension, longitudinal
distraction, and ischemia. The MOI underlying SCIWORA caused by spinal cord ischemic injury, which exhibits
remains unclear, as some patients initially present with similarities to a surfer’s myelopathy.
normal MRI findings. SCIWORA can be categorized based 3. Assessment and management
on the cause of injury:
i. SCIWORA caused by violent trauma (motor vehicle Managing SCIWORA in children, especially those aged
[11]
accidents and sports-related incidents), which has ≤8 years old, poses several challenges . SCIWORA
been reported by many researchers encompasses traumatic myelopathy, a condition not
ii. SCIWORA caused by minor trauma. associated with visible vertebral fractures or ligamentous
iii. Many children engage in backbend movement (repetitive abnormalities on ordinary radiographs and computed
hyperextension of the spine) during dance training tomography (CT) scans, with some cases even presenting
(Figure 1). This practice is common Chinese dance normal MRI findings [4,5,12] . These distinct case profiles
training and bears similarities to movements commonly exhibit significant variations in their presentation,
[13]
performed during surfing. Some children suffer medical management, and final neurologic outcome .
non-traumatic SCIWORA, necessitating differential In the early period following onset, SCIWORA patients
diagnosis to rule out conditions such as arteriovenous should undergo a neurological examination to assess
malformation, multiple sclerosis, acute transverse sensorimotor functions and determine the appropriate
myelitis, acute disseminated encephalomyelitis, infarction, treatment method. The American Spinal Injury
intramedullary neoplasms, and myelin oligodendrocyte Association Impairment Scale (ASIA) is recommended
glycoprotein antibody-associated disease [2,7-9] . External for evaluating their quality of daily life. ASIA is widely
forces acting on the pediatric spinal column often do used as a quantitative diagnostic classification tool for
not result in fractures but instead cause elongation, neurological assessment post-SCI [14,15] . Early identification
gliding, and vertebral slippage. Longitudinal traction of and evaluation of neurological deficits facilitate a deeper
the spine leads to violent distraction of the spinal cord, understanding and early intervention of each case .
[16]
causing nerve fiber rupture . Simultaneously, sustained Neurological deficits tend to worsen progressively and
[10]
or repeated hyperextension of the spine during dance should be subject to repeated evaluations. The neurological
training can lead to dynamic compression of the spinal dysfunctions typically reach their nadir after 8 – 24 h.
vessel, resulting in vascular injury, venous hypertension, Therefore, a case-by-case evaluation is essential before
and venous congestion, ultimately leading to spinal cord initiating SCIWORA management . The evaluation of
[17]
ischemic injury. At present, the MOI following sustained these cases goes beyond the ABCs of resuscitation .
[18]

Volume 7 Issue 1 (2024) 2 https://doi.org/10.36922/itps.1386