Most spinal cord injuries (SCI) are diagnosed by radiological imaging, most typically X-ray, computed tomography (CT), or magnetic resonance imaging (MRI). However, an estimated 6 to 19% of people with SCI do not show abnormalities on radiographic imaging, which can delay diagnosis and may result in poor health outcomes. “SCI without Radiographic Abnormal” (SCIWORA) is a diagnosis significantly more common in children, whose unique anatomical features (such as spinal soft tissue elasticity and immature vertebrae) reduce the likelihood that SCI can be visualized as a fracture or bone misalignment upon imaging. Accordingly, school-age children represent a particularly vulnerable population in the context of timely SCI diagnosis and treatment.
A recent study investigated risk factors and prognosis associated with pediatric SCIWORA. Using medical records from 16 pre-school and school-age patients with SCIWORA, the research team analyzed relevant data such as injury severity, American Spinal Injury Association (ASIA) Impairment scores, and imaging results. Their analysis revealed that:
- Children younger than seven years were more vulnerable to SCIWORA and had higher ASIA scores than children older than seven.
- These age-based differences in ASIA scores remained similar even after rehabilitation.
- The majority of injuries were caused by falls and recreational physical activities, namely dance and taekwondo.
- Most of the injuries occurred in the thoracic spinal cord, the region of the spine between the neck and lower back.
Compared to school-aged children, children younger than seven years old in China are especially vulnerable to SCIWORA and are more likely to suffer a higher degree of impairment. Parents of children who engage in recreational physical activities are advised to monitor their children for signs of SCI following a physical injury, even those that appear mild. Further research is needed to develop more reliable non-radiological methods to diagnosis SCI in children.
Liang J, Wang L, Hao X, et al. Risk factors and prognosis of spinal cord injury without radiological abnormality in children in China. BMC Musculoskeletal Disorders. (May 2022).