Brockmeyer Douglas L, Gautam Diwas, Ravindra Vijay M, Cole Kyril, Russell Katie W, Iyer Rajiv R
1Department of Neurosurgery, University of Utah, Salt Lake City.
2Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah.
J Neurosurg Pediatr. 2025 Sep 5:1-6. doi: 10.3171/2025.3.PEDS24537.
The concept of spinal cord injury without radiographic abnormality (SCIWORA) was introduced in the 1980s. Unfortunately, the nomenclature creates confusion in the modern MRI-based era when applied to pediatric traumatic spinal injuries. The authors investigated the incidence and clinical characteristics of pediatric patients with true imaging-negative traumatic cervical spinal cord injuries (SCIs).
A prospective pediatric level I trauma center database at Primary Children's Hospital was queried to identify patients with cervical spine injuries tagged with "SCIWORA" or "transient spinal cord injury." Demographic and clinical data were analyzed retrospectively after applying the following inclusion criteria: patient age < 18 years, evidence of transient neuropraxia on neurological examination, cervical spine MRI available for review, Glasgow Coma Scale (GCS) score ≥ 8, no intracranial pressure monitoring during hospitalization, and no evidence of SCI on MRI.
A total of 22,909 patients were entered into the trauma database from 2005 to 2022. Of the 226 patients who met the initial search criteria, 21 met the final inclusion criteria. Eighteen patients (85.7%) were male, and the mean age was 13.66 ± 2.48 years. The median GCS score was 15 (IQR 13-15). Neurological deficits noted on presentation included sensory, motor, and rectal tone loss in 19 (90.5%), 19 (90.5%), and 1 (4.8%) patient, respectively. The most common mechanism of injury was American football (10 patients, 47.6%), followed by wrestling (4, 19.0%) and motor vehicle collisions (2, 9.5%). The mean hospital stay was 1.81 ± 0.98 days (range 1-5 days), with 3 (14.3%) patients admitted to the pediatric ICU for 1.33 ± 0.58 days on average. All 21 patients were initially managed with a rigid cervical orthosis worn for 1-42 days (mean 4.57 ± 5.42 days). Neurological symptoms completely resolved by discharge in 16 (76.2%) patients. The time necessary for neurological recovery was 1-15 days (mean 2.24 ± 3.34 days). No patient required surgery or prolonged collar usage.
In this cohort, patients with MRI-negative neuropraxic cervical SCI were predominantly adolescent male athletes who recovered from their injuries within a few days without surgery or prolonged use of cervical collars. The authors assert that the term "transient spinal neuropraxia in pediatric patients" (T-SNIPP) is more appropriate to describe these injuries in the modern, MRI-based era of pediatric trauma care.
脊髓损伤无影像学异常（SCIWORA）这一概念于20世纪80年代被提出。遗憾的是，在现代基于磁共振成像（MRI）的时代，当应用于儿童创伤性脊髓损伤时，该命名会造成混淆。作者调查了真正影像学阴性的儿童创伤性颈脊髓损伤（SCI）患者的发病率及临床特征。
查询 Primary Children's Hospital 的前瞻性儿童一级创伤中心数据库，以确定标记为“SCIWORA”或“短暂性脊髓损伤”的颈椎损伤患者。在应用以下纳入标准后，对人口统计学和临床数据进行回顾性分析：患者年龄<18岁，神经学检查有短暂性神经失用的证据，有颈椎MRI可供审查，格拉斯哥昏迷量表（GCS）评分≥8，住院期间未进行颅内压监测，且MRI上无SCI证据。
2005年至2022年共有22909例患者进入创伤数据库。在符合初始搜索标准的226例患者中，21例符合最终纳入标准。18例（85.7%）为男性，平均年龄为13.66±2.48岁。GCS评分中位数为15（四分位间距13 - 15）。就诊时发现的神经功能缺损分别包括19例（90.5%）感觉、19例（90.5%）运动和1例（4.8%）直肠张力丧失。最常见的损伤机制是美式橄榄球（10例患者，47.6%），其次是摔跤（4例，19.0%）和机动车碰撞（2例，9.5%）。平均住院时间为1.81±0.98天（范围1 - 5天），3例（14.3%）患者平均入住儿科重症监护病房1.33±0.58天。所有21例患者最初均采用佩戴1 - 42天（平均4.57±5.42天）的硬质颈托进行处理。16例（76.2%）患者出院时神经症状完全缓解。神经功能恢复所需时间为1 - 15天（平均2.24±3.34天）。无患者需要手术或长期使用颈托。
在该队列中，MRI阴性的神经失用性颈脊髓损伤患者主要为青少年男性运动员，他们在数天内康复，无需手术或长期使用颈托。作者认为，在现代基于MRI的儿童创伤护理时代，“儿童短暂性脊髓神经失用”（T - SNIPP）这一术语更适合描述这些损伤。
