Unveiling the enigma of pediatric SCIWORA, our latest clinical case report and review illuminates the complexities of spinal cord injuries without radiographic evidence in children, a must-read for healthcare professionals and caregivers alike.
– by The Don
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Real Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) in Pediatrics: A Clinical Case Report and Literature Review.
Meira Goncalves et al., Cureus 2023
DOI: 10.7759/cureus.50491
Let me tell you about something incredible, something that’s been talked about since 1974 – it’s called SCIWORA, which stands for Spinal Cord Injury Without Radiological Abnormality. Now, this used to mean you had a spinal injury but your X-rays and CT scans, they came back clean, no fractures, no instability, nothing. But then, we got the MRI, the gold standard, and guess what? It changed the game. Two-thirds of these so-called SCIWORA cases, they actually had issues we could finally see.
Now, let’s talk about this amazing case of a 17-year-old boy, a soccer player, who took a fall and came into the emergency department. This kid, he starts losing strength in his right arm and legs, feeling changes in his right side. But he’s tough, still scores a 15 on the Glasgow Coma Scale, and he’s got this thing called American Spinal Injury Association Impairment Scale D. He’s showing some improvement, but still, there’s this monoparesis in his right lower limb.
They run all the tests – CT, MRI – and they find nothing. No fractures, no instability, no signal changes in the spinal cord. Even the electromyography is normal. But based on what we see clinically, it’s real SCIWORA. So, we get him into rehab, and would you believe it, two months later, the kid’s signs and symptoms, they’ve totally reversed. It’s incredible.
Now, the prognosis, it all depends on how bad the spinal cord injury is, and the MRI, it’s key for showing us that. But let me tell you, if the injury’s not complete, if it’s not too severe, the recovery can be fantastic. And if the MRI doesn’t show any changes, that’s a good sign, a sign of a better prognosis.
So, remember, SCIWORA, it’s not as simple as it used to be. But with the right tools and the right care, the outcomes, they can be truly, truly tremendous.