Palombi Davide, Galeazzi Marco, Brigato Paolo, De Salvatore Sergio, De Saint Denis Timothée, Massimi Luca, Tamburrini Gianpiero, Oggiano Leonardo
Department of Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
J Clin Med. 2025 Sep 8;14(17):6338. doi: 10.3390/jcm14176338.
Among the spectrum of spinal injuries, Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) occupies a unique and challenging position. SCIWORA presents diagnostic and therapeutic challenges due to its broad clinical and radiological heterogeneity. While most children recover favorably with conservative treatment, a subset may require surgery based on imaging findings. The findings underscore the need for standardized diagnostic criteria, MRI-based classification systems, and evidence-based treatment algorithms to improve consistency in care and long-term neurological outcomes. A systematic search of PubMed, Cochrane, Scopus, and Embase databases was performed through June 2025 following PRISMA guidelines. Inclusion criteria encompassed studies of pediatric SCIWORA (age < 18 years) reporting demographics, clinical and radiological features, management, and outcomes. Sixty studies encompassing a total of 848 pediatric patients were included. The mean patient age was 9.33 years (±2.52), with a slight male predominance. The most common trauma mechanisms were road traffic accidents (40.3%), sports injuries (22%), and falls (18.8%). MRI findings were available in 399 cases: 46% had intraneural lesions (Type IIb), 39% showed no abnormality on MRI (Type I, or "real SCIWORA"), 9% had combined lesions (Type IIc), and 6% had extraneural abnormalities (Type IIa). Neurological severity at presentation was primarily ASIA Grade A (46.25%), but follow-up data showed substantial improvement, with ASIA E (normal function) increasing to 49.78%. Overall, 66.2% of patients experienced neurological improvement, while 33.8% remained stable. Conservative treatment was employed in 95.41% of cases. Only 4.59% underwent surgery, which was typically reserved for MRI-positive lesions demonstrating spinal instability or compression. Pediatric SCIWORA remains an uncommon but potentially devastating injury, with an outcome highly dependent on MRI findings and initial neurological status. This systematic review aims to clarify the contemporary understanding of pediatric SCIWORA, delineating "real" SCIWORA from other SCIWORA-like entities, and synthesizing the latest evidence regarding epidemiology, mechanisms, clinical presentation, MRI findings, and management in children.
在一系列脊柱损伤中，无放射学异常的脊髓损伤（SCIWORA）占据着独特且具有挑战性的地位。由于其广泛的临床和放射学异质性，SCIWORA带来了诊断和治疗方面的挑战。虽然大多数儿童通过保守治疗恢复良好，但一部分儿童可能需要根据影像学检查结果进行手术。这些研究结果强调了需要标准化的诊断标准、基于MRI的分类系统以及循证治疗算法，以提高治疗的一致性和长期神经学预后。按照PRISMA指南，对PubMed、Cochrane、Scopus和Embase数据库进行了系统检索，截止至2025年6月。纳入标准包括关于儿童SCIWORA（年龄<18岁）的研究，这些研究报告了人口统计学、临床和放射学特征、治疗及预后情况。共纳入60项研究，涉及848例儿科患者。患者平均年龄为9.33岁（±2.52），男性略占多数。最常见的创伤机制是道路交通事故（40.3%）、运动损伤（22%）和跌倒（18.8%）。399例患者有MRI检查结果：46%有神经内病变（IIb型），39%MRI无异常（I型，即“真正的SCIWORA”），9%有合并病变（IIc型），6%有神经外异常（IIa型）。就诊时神经严重程度主要为美国脊髓损伤协会（ASIA）A级（46.25%），但随访数据显示有显著改善，ASIA E级（功能正常）增至49.78%。总体而言，66.2%的患者神经功能得到改善，33.8%保持稳定。95.41%的病例采用保守治疗。仅4.59%的患者接受了手术，手术通常用于MRI阳性且显示脊柱不稳定或受压的病变。儿童SCIWORA仍然是一种罕见但可能具有毁灭性的损伤，其预后高度依赖于MRI检查结果和初始神经状态。本系统评价旨在阐明对儿童SCIWORA的当代认识，将“真正的”SCIWORA与其他类似SCIWORA的实体区分开来，并综合有关儿童流行病学、机制、临床表现、MRI检查结果及治疗的最新证据。
