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INNOSC Theranostics and
Pharmacological Sciences Spinal cord injury without radiological abnormalities

mitigate the risk of disease recurrence, patients are advised in case a child experiences SCIWORA symptoms. In
to avoid physical activities during the first 6 months post- addition, health-care professionals should be vigilant, as
treatment [81,100] . In cases of asymptomatic craniocervical some SCIWORA cases may present with normal initial
arterial dissection, the use of aspirin, clopidogrel, or other MRI scans.
antithrombotic agent for 3 to 6 months is recommended
as first-line therapy. Furthermore, if symptoms progress, 9. Conclusion
consideration may be given to anticoagulation therapy (using SCIWORA is frequently diagnosed in children aged
low-molecular-weight heparin or warfarin). It is important ≤8 years old, and the unique characteristics of the pediatric
to note that these medical therapies carry an increased risk of spinal cord play a critical role in this condition. Various
[39]
hemorrhage . In addition, conducting post-operative CT MOIs can result in SCI or ischemia. The objective of this
and MRI on the 2 day following treatment can help assess guideline is to provide a comprehensive framework and
nd
treatment complications, monitor the patient’s progress, and treatment approach for addressing SCIWORA in children.
evaluate the stability of the injury [101] . Moving forward, effective treatments should be developed
7. Prognosis through multidisciplinary collaboration and supported
by robust evidence-based medicines. As new treatment
Differences in the MOI present significant challenges in measures continue to evolve to improve the quality of life
the diagnosis, treatment, and prognosis of SCIWORA. for children with SCIWORA, this guideline will undergo
SCIWORA can be devastating. According to the previous further revisions and improvements.
reports, early improvement within the first 24 – 72 h of
presentation has been observed in some patients. Children Acknowledgments
who experience minor trauma, have incomplete injuries, We would like to thank the medical team of the Orthopedics
or remain stable throughout treatment can achieve full
recovery. In contrast, the prognosis for patients with Department, especially Dr. Jamal Alshorman and the
Union Hospital Orthopedics team, who contributed to the
complete injuries, instability, or worsening symptoms ideas and for editing and revision of this manuscript.
depends on factors such as the treatment method,
treatment time, and the severity of injury. Moreover, the Funding
presence of spinal cord disruption or major hemorrhage on
MRI in cases of severe neurologic deficit is associated with This research was funded by the National Natural Science
a poor prognosis. Conversely, mild SCIWORA (spinal cord Foundation of China (grant number: 82072556).
concussion) usually results in full recovery, and a normal
MRI appearance is indicative of a favorable prognosis . Conflict of interest
[81]
The use of DTI and DTT to categorize SCI can help in All the authors declare no conflicts of interest.
determining the severity, prognosis, and optimizing
diagnosis by detecting microscopic pathological changes Author contributions
in the WM [34,43,93] . The prognosis in cases of SCIWORA Conceptualization: Ruba Altahla, Xu Tao
depends on the child’s age, injury location, neurological Writing – original draft: Ruba Altahla, Jamal Alshorman
examination findings, detected MRI abnormalities, and Writing – review & editing: Jamal Alshorman
classification based on DTI-DTT.
Ethics approval and consent to participate
8. Prevention
Not applicable.
Given the rarity and complexity of SCIWORA cases,
where multiple treatment attempts often fail to control the Consent for publication
condition, it becomes imperative to address the underlying
causes. Public awareness, especially among individuals Not applicable.
and their families, is crucial, particularly for children Availability of data
under the age of 8 who may exhibit warning signs. Those
engaged in activities involving prolonged and repeated Not applicable.
spinal hyperextension, such as dance instructors, should
take measures to minimize this risk. Parents should avoid References
actions that could potentially harm their child’s spine, 1. Pang D, 2004, Spinal cord injury without radiographic
such as shaking the baby or rough handling. It is essential abnormality in children, 2 decades later. Neurosurgery,
for everyone to be well-informed about how to respond 55: 1325–1342; discussion 1342–1343.

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