Management and Mid-Term Outcome After “Real SCIWORA” in Children and Adolescents

• Published in: Global spine journal Vol. 12; no. 6; pp. 1208 - 1213
• Main Authors: Freigang, Viola, Butz, Katja, Seebauer, Caroline Theresa, Karnosky, Julia, Lang, Siegmund, Alt, Volker, Baumann, Florian
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.07.2022; Sage Publications Ltd
• Subjects: Clinical outcomes; Disability; Original; Pediatrics; Spinal cord injuries; Trauma; patient-reported outcome; pediatric and adolescent trauma; management of severe trauma; SCIWORA
• ISSN: 2192-5682; 2192-5690
• DOI: 10.1177/2192568220979131

Study Design: Retrospective analysis. Objective: The SCIWORA Syndrome (Spinal Cord Injury Without Radiographic Abnormalities) is a rare but potentially severe injury with a peak in childhood and adolescence. With a better understanding of injury patterns and advances in MRI, there is ongoing discussion regarding the “Real SCIWORA” syndrome, a clinical picture of neurologic deficits on clinical examination but absence of radiographic pathologies even on MRI. The purpose of this study was to evaluate mid-term clinical outcome and the psychological impact of the “Real SCIWORA.” Methods: In this retrospective analysis, we evaluated 32 patients treated for “Real SCIWORA” between 2007-2019. Inclusion criteria were: neurologic deficit after trauma, no other cerebral or skeletal injury and a lack of pathological findings in spinal MRI. All patients were followed until complete recovery from initial symptoms. 25/32 patients were re-evaluated after 6.9 years (1-14 years) using the Oswestry Disability Index, the Frankel Score, the EQ-5D score, and the Breslau Short Screening Scale for PTSD. Results: Initial neurologic presentation ranged from Frankel Grade A-D. All patients recovered neurologically during 1-13 days to a Frankel Grade E. The analysis of HR-QoL revealed no difference between the cohort of SCIWORA patients and the German population norm, Oswestry Disability Index showed only minimal disabilities. 4/25 patients showed signs of PTSD. Conclusions: The “Real SCIWORA” syndrome is a diagnosis per exclusionem requiring a full spinal MRI to ensure exclusion of structural and potentially serious reasons of the neurologic impairment. Further clinical re-evaluation, psychological support seems to be essential. Level of Evidence: IV—retrospective study.