Transient spinal neuropraxia in pediatric patients: analysis of an institutional experience 4 decades after the introduction of spinal cord injury without radiographic abnormality.

OBJECTIVE

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).

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.