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. 2022 Jul;12(6):1208-1213.
doi: 10.1177/2192568220979131. Epub 2021 Jan 7.

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

Viola Freigang  1 , Katja Butz  1 , Caroline Theresa Seebauer  2 , Julia Karnosky  3 , Siegmund Lang  1 , Volker Alt  1 , Florian Baumann  1
Affiliations

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

Viola Freigang et al. Global Spine J. 2022 Jul.

Abstract

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.

Keywords: SCIWORA; management of severe trauma; patient-reported outcome; pediatric and adolescent trauma.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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