Spinal cord injury without radiographic abnormality in children.

Between 1970 and 1988, 35% of children with traumatic myelopathy demonstrated spinal cord injury without radiographic abnormality (SCIWORA). Young children, especially children under 3 years were particularly vulnerable. Mechanisms of injury were age-specific and included flexion, hyperextension and longitudinal traction. Over 80% of injuries involved the cervical cord. Ninety-five percent of all severe injuries occurred in younger children. Neurologic recovery was directly dependent on the degree of initial neurologic injury. Management included dynamic films to exclude obvious fracture or instability, CT or polytomography to exclude occult fracture, and MRI or CT-myelography to exclude surgical lesions. Cervical immobilization is the cornerstone of therapy for prevention of recurrent episodes of SCIWORA.