SCIWORA is a syndrome with neurological deficits without osseous abnormality on XR or CT.
Many patients with SCIWORA have myelopathy.
Mechanism of injury: Most commonly caused by hyperextension or flexion. Other possible mechanisms include rotational, lateral bending, or distraction.
Population: More common in younger children. This comprises 1/3 of pediatric trauma cases that have neuro deficits on exam.
Severity depends on degree of ligamentous injury. It can be mild to severe, and cases have the potential to be unstable.
Management: Immobilize cervical spine and consult neurosurgery. Patients often need prolonged spinal immobilization.
If the patient is altered and an adequate neurological exam cannot be obtained, a normal CT or XR of the cervical spinal is not sufficient to rule out spinal cord injury. It is important to continue monitoring neurological status. One possible etiology is spinal cord hemorrhage, and serial exams are essential.
References
Nagler J, Farrell CA, Auerbach M et al. "Trauma." Atlas of Pediatric Emergency Medicine, edited by Binita S, 3rd edition. McGraw Hill, 2019, 996-997.
