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Liu R, Fan Q, He J, Wu X, Tan W, Yan Z, Wang W, Li Z, Deng YW. Clinical characteristics analysis of pediatric spinal cord injury without radiological abnormality in China: a retrospective study. BMC Pediatr 2024; 24:236. [PMID: 38570804 PMCID: PMC10988788 DOI: 10.1186/s12887-024-04716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE This study aims to analyze the clinical characteristics of Chinese children with spinal cord injury (SCI) without radiographic abnormality (SCIWORA) and explore their contributing factors and mechanisms of occurrence. METHODS A retrospective analysis was conducted on the clinical data of pediatric patients diagnosed with SCIWORA from January 2005 to May 2020. Epidemiological, etiological, mechanistic, therapeutic, and outcome aspects were analyzed. RESULTS A total of 47 patients with SCIWORA were included in this study, comprising 16 males and 31 females. The age range was 4 to 12 years, with an average age of 7.49 ± 2.04 years, and 70% of the patients were below eight. Sports-related injuries constituted 66%, with 70% attributed to dance backbend practice. Thoracic segment injuries accounted for 77%. In the American Spinal Injury Association (ASIA) classification, the combined proportion of A and B grades accounted for 88%. Conservative treatment was chosen by 98% of the patients, with muscle atrophy, spinal scoliosis, hip joint abnormalities, and urinary system infections being the most common complications. CONCLUSION SCIWORA in Chinese children is more prevalent in those under eight years old, with a higher incidence in females than males. Thoracic spinal cord injuries are predominant, dance backbend as a primary contributing factor, and the social environment of "neijuan" is a critical potential inducing factor. Furthermore, the initial severity of the injury plays a decisive role in determining the prognosis of SCIWORA.
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Affiliation(s)
- Renfeng Liu
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Qizhi Fan
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jingpeng He
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xin Wu
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Wei Tan
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Zuyun Yan
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Weiguo Wang
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Zhiyue Li
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - You-Wen Deng
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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Romero-Muñoz LM, Peral-Alarma M, Barriga-Martín A. [Translated article] SCIWORA in children. A rare clinical entity: Ambispective study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T151-T158. [PMID: 37995819 DOI: 10.1016/j.recot.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/22/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P=0.872), age and MRI spinal cord findings (P=0.149) were found in SCIWORA patients.
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Affiliation(s)
- L M Romero-Muñoz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, Spain.
| | - M Peral-Alarma
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - A Barriga-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, Spain
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Romero-Muñoz LM, Peral-Alarma M, Barriga-Martín A. SCIWORA in children. A rare clinical entity: Ambispective study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:151-158. [PMID: 37689351 DOI: 10.1016/j.recot.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P = 0.872), age and MRI spinal cord findings (P = 0.149) were found in SCIWORA patients.
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Affiliation(s)
- L M Romero-Muñoz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, España.
| | - M Peral-Alarma
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, España
| | - A Barriga-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, España
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Meira Goncalves J, Carvalho S, Silva AI, Pereira J, Polónia P. Real Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) in Pediatrics: A Clinical Case Report and Literature Review. Cureus 2023; 15:e50491. [PMID: 38222116 PMCID: PMC10787207 DOI: 10.7759/cureus.50491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Spinal cord injury without radiological abnormality (SCIWORA) was first reported in 1974. The term was used to define "clinical symptoms of traumatic myelopathy without signs of fracture or spine instability on X-ray or CT scan." With the emergence of MRI, the gold standard method to identify spinal cord injuries, about two-thirds of former SCIWORA cases were found to have pathological findings, and, as such, the term has taken on an ambiguous meaning in the literature. We describe the clinical case of a 17-year-old boy who was admitted to the emergency department of a tertiary hospital after a fall during a soccer game. He suffered spinal and cranioencephalic trauma. A few minutes later, the boy began to show decreased strength in the right upper limb and lower limbs, as well as changes in sensation in the right hemibody. On objective examination, the boy presented a Glasgow Coma Scale score of 15 and the American Spinal Injury Association Impairment Scale D, with partial improvement of initial symptoms of monoparesis of the right lower limb. There were no other changes, specifically at the sensory level. The patient underwent a CT and MRI of the spine that showed no fractures, instability, or appreciable medullary signal changes. Electromyography was normal. Based on the clinical history and imaging findings, real SCIWORA was diagnosed. The patient was admitted to an inpatient rehabilitation program. At a follow-up visit two months later, a complete reversal of signs and symptoms was confirmed. The prognosis of this pathology depends on the extent of the spinal cord injury, as evidenced by MRI. Although neurological improvement when severe deficit is present at initial presentation is unlikely, most patients with incomplete neurological damage show good recovery. The absence of visible changes on MRI is associated with a better prognosis.
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Affiliation(s)
| | - Sara Carvalho
- Neuroradiology, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Ana Isabel Silva
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Josué Pereira
- Neurosurgery, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Patricia Polónia
- Neurosurgery, Centro Hospitalar Universitário de São João, Porto, PRT
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Clinical characteristics and treatment of spinal cord injury in children and adolescents. Chin J Traumatol 2023; 26:8-13. [PMID: 35478089 PMCID: PMC9912187 DOI: 10.1016/j.cjtee.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/24/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Pediatric and adult spinal cord injuries (SCI) are distinct entities. Children and adolescents with SCI must suffer from lifelong disabilities, which is a heavy burden on patients, their families and the society. There are differences in Chinese and foreign literature reports on the incidence, injury mechanism and prognosis of SCI in children and adolescents. In addition to traumatic injuries such as car accidents and falls, the proportion of sports injuries is increasing. The most common sports injury is the backbend during dance practice. Compared with adults, children and adolescents are considered to have a greater potential for neurological improvement. The pathogenesis and treatment of pediatric SCI remains unclear. The mainstream view is that the mechanism of nerve damage in pediatric SCI include flexion, hyperextension, longitudinal distraction and ischemia. We also discuss the advantages and disadvantages of drugs such as methylprednisolone in the treatment of pediatric SCI and the indications and timing of surgery. In addition, the complications of pediatric SCI are also worthy of attention. New imaging techniques such as diffusion tensor imaging and diffusion tensor tractography may be used for diagnosis and assessment of prognosis. This article reviews the epidemiology, pathogenesis, imaging, clinical characteristics, treatment and complications of SCI in children and adolescents. Although current treatment cannot completely restore neurological function, patient quality of life can be enhanced. Continued developments and advances in the research of SCI may eventually provide a cure for children and adolescents with this kind of injury.
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Meng YF, Zhang JW, Tong AN, Tang HH, Bai JZ, Wang FY, Liu SJ, Lyu Z, Chen SZ, Liu JS, Hong Y. Prognosis of traumatic spinal cord injury in children: Follow-up of 86 patients. Chin J Traumatol 2023; 26:14-19. [PMID: 35691771 PMCID: PMC9912184 DOI: 10.1016/j.cjtee.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The long-term situation of children with spinal cord injury (SCI) was investigated, and suggestions for helping them better return to the society were provided. METHODS SCI patients less than 18 years old hospitalized in Beijing Boai Hospital from January 2011 to December 2020 were retrospectively analyzed. Information including motor function, complications, characteristic changes, self-care abilities, school attendance and social participation were collected by telephone interview and electronic questionnaire. All the answers were statistically analyzed. RESULTS A total of 86 cases were enrolled, 77 girls and 9 boys, with a median injury age of 6 years and 2 months. The follow-up time was 3-130 months. The main cause of trauma in these children was sport injury (66.3%), the thoracic spinal cord was involved the most (91.9%), and complete SCIs accounted for the majority (76.7%). In terms of complications, children with complete SCIs were more likely to have urinary incontinence, constipation and characteristic changes (p < 0.05); whereas the incomplete SCIs often have spasticity (p < 0.05). As to the daily living abilities, children with incomplete lumbar SCIs were more capable to accomplish personal hygiene, transfer, and bathing independently than those with complete injuries, or cervical/thoracic SCIs, respectively (p < 0.05). Moreover, children older than 9 years care more able to dress and transfer independently than the youngers (p < 0.05). Wheelchair users accounted for 84.9% and more than half of them were able to propel wheelchair independently, and those who move passively in wheelchairs were mostly introverted kids (p < 0.05). Almost all (93.8%) children with incomplete injuries were able to walk independently. Most (79.1%) children continued to attending school, and 41.9% participated in interest classes. Unfortunately, 67.4% of the children spent less time playing with their peers than before the injury. CONCLUSION SCIs impair physical structures and function of children, affect their independence in daily living, and restrict school attendance and social interaction. Comprehensive rehabilitation after injury is a systematic work. Medical staff and caregivers should not only pay attention to neurological function, but also help them improve self-care abilities. It is also important to balance rehabilitation training and school work and social participation.
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Affiliation(s)
- Yu-Fei Meng
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China
| | - Jun-Wei Zhang
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - An-Ni Tong
- Department of Rehabilitation Medicine, Beijing Haidian Hospital, Beijing, 100080, China
| | - He-Hu Tang
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Jin-Zhu Bai
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Fang-Yong Wang
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Shu-Jia Liu
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Zhen Lyu
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Shi-Zheng Chen
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Jie-Sheng Liu
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Yi Hong
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China; Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China.
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