Acronym for Spinal Cord Injury WithOut Radiographic Abnormality.

Pathology specific to children less than 8 years old who can develop serious injury of the cervical spinal cord without evident radiological lesions of the cervical spine are during a trauma to the cervical spine.

The causes of this fragility of the cervical spinal are:

-        a relatively larger and therefore heavier head

-        poorly developed neck muscles

-        vertebrae triangular shape (by profile) the facet joints of which are more horizontal than in adults: they "slip" more easily over each other.

-        very elastic ligaments, allowing a significant displacement of the bony structures without fracture and their rapid return to normal position.

The location of the cervical spinal cord injury also varies with age: the region C1-C4 is more at risk in children less than 8 years of age; later, it is essentially the C5-C8 area that is affected.

50 % of children suffering from SCIWORA present from the start with severe neurological injury (para- or tetraplegia, muscle weakness), but others have only discrete and transient neurological signs at the time of the trauma but show progressing neurological deterioration in the following days. The cervical spine made unstable by the first trauma (but the instability of which was masked by muscle spasm) and/or the cervical medulla that suffered a transient ischemic attack, progressively decompensate following a new minor mobilization (another minor trauma, intubation maneuvers).

It is essential to prevent this secondary deterioration:

-        by knowing this typical pediatric pathology

-        by questioning the child or its parents about the very transient presence of neurological symptoms immediately after  the trauma: weakness ? paresthesia ? "electric shocks" in the limbs ?

-        by securing, by means of a suitable neck brace, the cervical spine of patients for who this pathology is suspected until a radiological evaluation (MRI or CT, because conventional X-rays looking for a ligamentous instability are poorly  performing as long as there is a spasm of the cervical muscles).

The younger the child, the higher the risk of severe neurological damage and overall mortality.

Anesthetic implications:

Cervical spine should be suspected in any polytraumatized child or who has suffered an injury where the cervical spine has been strongly flexed, extended, crushed or stretched (deceleration, stroke-backlash)

References : 

-        Kriss VM, Kriss TC
SCIWORA in infants and children.
Clinical Pediatrics 1996, 119-124 

Updated: September 2018