ABSTRACT
Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.
Subject(s)
Child , Humans , Spinal Cord Injuries/complications , Spinal CordABSTRACT
Resumen: El término SCIWORA (Spinal Cord Injury Without Radiologic Abnormality) describe una patología poco frecuente que afecta principalmente a pacientes pediátricos. Presentamos el caso de un paciente adolescente diagnosticado con SCIWORA/síndrome de Brown Séquard, el cual presenta múltiples contusiones en cuello y hemicuerpo derecho, de manera inmediata refiere parestesias en las cuatro extremidades y hemiparesia espástica con predominio derecho, incapacidad a la bipedestación y continencia urinaria. Se inicia tratamiento basado en el estudio NASCIS III y posterior a la pruebas de imagen se realizó diagnóstico ya comentado. Exponemos las definiciones más actuales de SCIWORA y las recomendaciones para realizar su diagnóstico así como su relación y coexistencia con síndromes medulares.
Abstract: SCIWORA (Spinal Cord Injury without Radiologic Abnormality) is a rare condition that mainly affects pediatric patients; We present the case of a teenage male patient diagnosed with SCIWORA/Brown Séquard Syndrome. In admission, he has multiple bruises on his neck and right hemibody and immediately he refers paraesthesia in all four limbs and spastic hemiparesis with right predominance, as well as inability to stand up and urinary continence. Treatment based on NASCIS III study is initiated and after the imaging tests, a diagnosis has already been made. We present the most current definitions of SCIWORA and the recommendations to make its diagnosis, as well as its relationship and coexistence with spinal syndromes.
ABSTRACT
Objective: The present study was design to investigate the clinical profile and outcome in patients of cervical spinal cord injury with or without bony injury. Material and Method: All patients of cervical spinal cord injury with or without evidence of bony injury on X–ray were included in this study. In addition to X–ray finding, patient age, sex and MRI cervical spine were also recorded at the time of admission. Clinical profile and outcome was assess with Benzel–Larson Grade included one to seven grades. Results: Total 87 patients of cervical spine injury were included in study, 25 patients were included in SCIWORA group while 62 patients were having associated with bony injuries. Both SCIWORA and SCI with bony injury ware more commonly due to fall from height and more common in males. Neurological recovery was more in SCIWORA than bony injury patients. Conclusion: cervical spine cord injury is commonly seen in children, while associated bony injury is common in adult population. Early diagnosis and proper management for SCIWORA can improve neurological outcome in selected group of patients.
ABSTRACT
Acute spinal cord injury strikes labour active young and middle-aged population, especially men, and consequently usually results in difficult neurological sequel. Also disables normal quality of life and everyday functioning in these patients despite many available supportive measures. Spinal cord injury wit hout radiological abnormality (SCIWORA) presents a great diagnostic challenge because radiological and computed tomography pictures are without visible pathology which would explain the new onset of the neurological deficit. For the first time we report a true spinal cord injury without radiological abnormality in the X-ray, computed tomography and magnetic resonance imaging in a young female manifested with moderate neurological deficit after the traffic accident. Although SCIWORA is very rare in adults, high level of suspicion in emergency department is advisable as the timely applied neuroprotective measures can prevent the onset of the neurological deficit. It is important to emphasize that emergency magnetic resonance imaging application is the diagnostic key. Albeit, the SCIWORA neurologic deficit can show up with a delay of four days after the spinal cord injury in a patient with a normal physical and radiological examination. Treatment of these patients is another challenge for every physician. In fact pharmacological treatment options are still in the experimental research phase. We can conclude that currently the neuroprotective measures of the acute spinal cord injury patient started in the emergency department regardless the radiological test findings represent the right and successful key treatment.
ABSTRACT
El objetivo del presente trabajo es difundir en la comunidad médica el acrónimo SCIWORA y destacar la importancia de la Resonancia Magnética (RM) como herramienta sensible para su diagnóstico. Esta entidad se caracteriza por una lesión traumática de la médula espinal, en ausencia de anormalidad radiológicamente demostrable. Es única en niños, generalmente en menores de 8 años, con una incidencia estimada en 3,3% y 32 %. Esta brecha estadística se explica, en parte, por la edad de los grupos, el sitio donde reciben atención médica y particularmente por el acceso a la RM. Las lesiones medulares traumáticas son infrecuentes en la edad pediátrica y presentan el 5 % de todas las lesiones del raquis. La existencia de SCIWORA se explica por las condiciones anatómicas y biomecánicas del raquis en niños de esta edad.
The aim of this manuscript is to clarify the acronym SCIWORA among the medical community, and to highlight the importance of magnetic resonance imaging (MRI) as a sensitive tool for the diagnosis of this condition. SCIWORA is characterized by spinal cord injury, with normal radiology. It can only be diagnosed by MRI, although there is some controversy on this concept. It only occurs in children under 8 years of age, with an incidence ranging between 3.3% and 32%, which depends on age of the patient, degree of complexity of the health center and especially the access to MRI. Traumatic spinal cord injuries are rarely found in children, and account for 5% of all spinal lesions. In children, the presence of SCIWORA is associated with the anatomical and biomechanical characteristics of the spine.
ABSTRACT
A spinal cord injury without radiographic abnormality(SCIWORA) was defined by Pang and Wilberger in 1982 as the "objective signs of myelopathy as a result of trauma" in which no evidence of fracture, subluxation, or instability on plain radiographs, or computed tomography is demonstrable. Inherent elasticity of the vertebral column in infants and young children, among other age-related anatomical peculiarities, render the pediatric bony cervical and thoracic spine exceedingly vulnerable to deforming forces. We report here on a case of SCIWORA in a 3-year-old girl who presented with lower extremity paralysis, paresthesia, and voiding difficulty. The mechanism of neural damage in this case was purely longitudinal distraction. Such stress on the spine resulted from severe pulling up the lower extremity by her father, which was not thought to be damaging at that time.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Elasticity , Fathers , Lower Extremity , Paralysis , Paresthesia , Spinal Cord Diseases , Spinal Cord Injuries , Spinal Cord , SpineABSTRACT
@#The authors retrospectively analysed 67(63 in cervical cord)cases of traumatic SCIWOAR with positive MR abnormalities. It was deduced that the cases of SCIWOAR might be related with (1)those traumatic forces resulting in SCI being not so heavy and severe, (2)the cases orignally with cervical spondylopathy,(3)the limitation of the conventional X-ray examination for SCI,and (4)the cases of children relativly rare in our country and hospital.The ALL hematomas are the pathognomonic signs in the case of the acute cervical SCI within one week.The analysis demonstrated that MR investigation of the traumatic spine could give the clinical activities the correct diagnosis of different degree of SCI and dependable reference.