Spine – SCIWORA
Spinal Cord Injury Without Radiographic Abnormality
– usually less than 8 years old; most with severe spinal cord involvement are less than 4
– related to hypermobility of c-spine
– the injuries may not be mechanically unstable
Need x-rays, CT, MRI – look at the cord
It is possible that none of the investigations will show an osseous or even a ligamentous injury
– key to treatment is to provide protection against further spinal cord damage.
– rarely need surgery (only if you see a lesion that needs fixing!)
– usually, there is no radiographic or MRI signs of instability and the child is treated with some form of orthosis
– watch for late spinal paralytic deformity in a kid with quadriplegia. In children who are paralyzed prior to the teenage growth spurt – all develop spinal deformity – 80% of which will be progressive, 61% of which will need spinal fusion.