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INNOSC Theranostics and
Pharmacological Sciences Spinal cord injury without radiological abnormalities

Furthermore, there is a lack of evidence supporting the use to a trauma facility capable of diagnosing and treating
of drugs in the treatment of SCIWORA in children. the patient
ii. Maintain immobilization until the patient becomes
6.3.1. Considerations for determining drug dosage asymptomatic

The determination of drug dosage should take into account iii. Discontinue cervical immobilization if an MRI
the following criteria: conducted within 48 h of injury reveals no pathological
i. Age of the children changes
ii. If the child’s age, weight, and vital signs are stable, iv. In cases associated with atlanto-occipital ligamentous
ensure open communication with the child’s family injuries, consider recommending halo vest
regarding the potential risks associated with the use of immobilization or occipitocervical stabilization and
these drugs fusion.
iii. For intravenous (IV) drug therapy, consider factors
such as infusion rate, body weight, dosage, initial 6.5. Surgery
IV dose, and maintenance infusion rate before Non-operative treatment is always the first choice for
administering MP SCIWORA, especially in cases of stable spine injuries.
iv. To minimize the risk of complications, discontinue Surgical intervention becomes an option if conservative
MP as soon as previous neurological issues have been therapy fails or if the injury is unstable. However, in cases of
resolved progressive neurologic deterioration with or without spinal
v. Ideally, pharmaceutical therapy should commence cord compartment syndrome or spinal cord intramedullary
within the first 8 h after the injury, but it can be hypertension during conservative treatment, as well as in
considered up to 24 h post-injury [76,78] instances involving cord compression due to a hematoma,
vi. Contraindications for MP use include patients at extruded disk, bony fragment, or unreduced dislocation,
risk of pneumonia, diabetes patients, those with immediate surgical intervention is required to achieve a
gastrointestinal abnormalities, a time gap of more favorable recovery. Surgical intervention, when indicated
than 24 h since injury, complete SCI, open injuries in SCIWORA cases, has been shown to be safe and
associated with SCI, and cases where operative associated with significant positive outcomes, especially
treatment is indicated. when performed promptly after the onset [47,49,75] . When
the thoracolumbar injury classification and severity score
6.4. Immobilization (TLICS) is <3, conservative treatment is generally suitable.
Immobilization serves as the first step in the treatment of However, when the score reaches 4 points, the decision
SCIWORA, with removal following injury stabilization . may lean toward operative or non-operative treatment.
[74]
Immediate immobilization at the accident scene should be Moreover, the TLICS system provides guidance for surgical
maintained until a comprehensive assessment of the child can treatment decisions in patients with a TLICS score of 5 or
be conducted. The practice is essential for preventing further higher [83,84] .
damage and risky activities [79,80] . External immobilization is
recommended for a duration of up to 12 weeks. Moreover, 6.5.1. Novel surgical approaches
early discontinuation is suggested for asymptomatic patients Non-fusion laminectomy, followed by immobilization, has
with confirmed spinal stability . Early immobilization is shown promise in significantly improving outcomes in
[81]
associated with a favorable prognosis. However, cervical children while reducing complications related to the growth
spine immobilization is complicated due to its intrinsic scales . However, it can have adverse effects on children’s
[85]
elastic characteristics. Furthermore, the inherent limitations growth, potentially leading to spine misalignment and
of the cervical collar (allowing some degree of rotation internal fixator loosening. Laminectomy is a procedure
leading to incomplete stability) and potential risks associated that can alleviate pressure on the spinal cord. However,
with the use of the halo vest (infection, pin loosening, and minimizing muscle dissection and reducing the number
psychological effects) are all crucial points to consider . of vertebrae involved in the laminectomy can enhance
[41]
The benefit of rigid immobilization is unproven in the case post-operative stability. In an effort to mitigate the
of strictly normal MRI . complications associated with other treatment methods
[82]
and achieve significant results, cerebrospinal fluid lumbar
6.4.1. Points to consider in immobilization following drainage has been considered as a potential treatment
points choice. It is essential to exercise caution when using this
i. Initiate early immobilization, perform extrication, approach, and further clinical studies are required to
provide initial resuscitation, and arrange for evacuation establish its effectiveness .
[86]

Volume 7 Issue 1 (2024) 5 https://doi.org/10.36922/itps.1386