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Pediatric Spinal Cord Injury without Radiographic Abnormality: A Meta-analysis.

Launay, Franck MD*; Leet, Arabella I MD†; Sponseller, Paul D MD†

Clinical Orthopaedics and Related Research (1976-2007): April 2005 - Volume 433 - Issue - pp 166-170
doi: 10.1097/

Using a meta-analysis, we identified 392 published cases of patients recently diagnosed with spinal cord injuries without radiographic abnormalities (SCIWORA) and studied the epidemiologic, pathophysiologic, clinical, and radiologic data. To describe those at risk for this uncommon syndrome, mainly pediatric patients (90% of the cases) who sustain serious trauma in car accidents, serious falls, sports injuries, or child abuse, we analyzed the reported information in the literature. Magnetic resonance imaging scans may indicate neural (hemorrhages, edema, or both) or extraneural (disc protusions, extradural hematomas) injuries, and the location and type of the injury. Every patient having magnetic resonance imaging scans had either intraneural or extraneural injury. However, followup magnetic resonance imaging scans are necessary because evidence of the injury might not appear immediately. Late and recurrent spinal cord injuries without radiographic abnormalities are reported. External immobilization for 12 weeks helps patients who are moderately injured and helps prevent recurrence of these types of injuries. Approximately 44% of the patients in our study did not recover whereas complete recovery occurred in 39% of the population. The prognosis can be improved if the syndrome is diagnosed early, so we recommend considering spinal cord injuries without radiographic abnormalities as a possible diagnosis for any child who has a mechanism of injury that suggests trauma to the spine.

Level of Evidence: Therapeutic study, Level III-3 (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.

From the *Service d'Orthopédie Pédiatrique, Hôpital Enfants La Timone, Marseille, France; and the †Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD

Received: November 6, 2003

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest with the content of the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

Correspondence to: Arabella I. Leet, MD, Department of Orthopedic Surgery, Johns Hopkins University, 601 North Caroline Street, Room 5255, Baltimore, MD 21287-0882. Phone: 410-955-4553; Fax: 410-614-1451; E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.