Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations

Abstract

Cervical trauma in children have variations from the adults mainly due to anatomic differences. An optimal diagnostic and treatment strategy is critical, particularly when there is a lack of standardized protocols for the management of such cases. This review paper examines the diagnostic and treatment options of pediatric cervical trauma and Spinal Cord Injury Without Radiographic Abnormality (SCIWORA). A literature search for the last 10 years were conducted using key words. Case reports, experimental studies, papers other than English language were excluded. Up-to-date information on pediatric cervical trauma and SCIWORA were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of WFNS Spine Committee. The statements were voted and reached a consensus using Delphi method. This review reflects different aspects of contemporary pediatric cervical trauma decision-making and treatment, and SCIWORA. The mainstay of SCIWORA treatment is nonsurgical with immobilization, avoidance of risky activities. Prognosis generally depends on the initial neurological status and magnetic resonance imaging. Due to a significant discrepancy in the literature on diagnostic and management, future randomized controlled trials are needed to aid in generating standardized protocols.

Keywords: Cervical spine; Pediatric trauma; Spinal cord injury; Spinal cord injury without radiographic abnormality.

Fig. 1.

Flow diagram showcasing the selection process of included publications.

Fig. 2.

SCIWORA algorithm recommended by Atesok et al. [57] SCIWORA, Spinal Cord Injury Without Radiographic Abnormality; SCI, spinal cord injury; SSEP, somato sensory evoked potentials; AP, anteroposterior; LAT, lateral; CT, computed tomography; MRI, magnetic resonance imaging.