title: Spinal cord injuries without radiographic abnormality at two pediatric trauma centers in Ontario.
abstract: BACKGROUND
  Spinal cord injury without radiographic abnormality (SCIWORA) represents a traumatic myelopathy, either transient or permanent, that is not associated with visible vertebral fractures or ligamentous abnormalities on plain radiographs or CT. MRI has become essential in the diagnosis and evaluation of trauma patients and in predicting the long-term neurological outcome.
  
  
  METHODS
  The medical charts of 578 children with vertebral trauma at the Children's Hospital of Eastern Ontario and the Hospital for Sick Children were retrospectively reviewed.
  
  
  RESULTS
  Forty-five patients were identified as having traumatic myelopathy. Three of these patients had SCIWORA. Two sustained thoracic spinal cord injuries as a result of motor vehicle accidents and permanent neurological deficits. The third was involved in a sports-related injury and sustained a cervical spine injury that improved in 48 h.
  
  
  CONCLUSIONS
  SCIWORA is uncommon. The serious neurological sequelae that can result from a missed diagnosis merit more attention in identifying a spinal lesion in children with traumatic myelopathy. MRI has played a valuable role in this respect and may be even more predictive of outcome than the presenting neurological findings. The SCIWORA acronym can be modified to SCIWONA (spinal cord injury without neuroimaging abnormality) in order to highlight the importance of MRI in the prognosis.
authors.affiliation: Division of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Ont., Canada.
authors.forename: T
authors.initials: T
authors.lastname: Trigylidas
authors.forename: S J
authors.initials: SJ
authors.lastname: Yuh
authors.forename: M
authors.initials: M
authors.lastname: Vassilyadi
authors.forename: M A
authors.initials: MA
authors.lastname: Matzinger
authors.forename: A
authors.initials: A
authors.lastname: Mikrogianakis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D009864:Ontario / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data