title: Spinal cord injury without radiologic abnormality in children imaged with magnetic resonance imaging.
abstract: BACKGROUND
  This study aimed to compare children diagnosed with cervical spinal cord injury without radiographic abnormality (SCIWORA) relative to whether there is evidence of cervical spinal cord abnormalities on magnetic resonance imaging (MRI).
  
  
  METHODS
  We conducted a planned subanalysis of a cohort of children younger than 16 years with blunt cervical spine injury presenting to Pediatric Emergency Care Applied Research Network centers from January 2000 to December 2004 who underwent cervical MRI and did not have bony or ligamentous injury identified on neuroimaging. We defined SCIWORA with normal MRI finding as children with clinical evidence of cervical cord injury and a normal MRI finding and compared them with children with SCIWORA who had cervical cord signal changes on MRI (abnormal MRI finding).
  
  
  RESULTS
  Of the children diagnosed with cervical spine injury, 55% (297 of 540) were imaged with MRI; 69 had no bony or ligamentous injuries and were diagnosed with SCIWORA by clinical evaluation; 54 (78%) had normal MRI finding, and 15 (22%) had cervical cord signal changes on MRI (abnormal MRI finding). Children with abnormal MRI findings were more likely to receive operative stabilization (0% normal MRI finding vs. 20% abnormal MRI finding) and have persistent neurologic deficits at initial hospital discharge (6% normal MRI finding vs. 67% abnormal MRI finding).
  
  
  CONCLUSIONS
  Children diagnosed with SCIWORA but with normal MRI finding in our cohort presented differently and had substantially more favorable clinical outcomes than those with cervical cord abnormalities on MRI.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: From the Division of Emergency Medicine (P.M.), Department of Pediatrics, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit; and Departments of Emergency Medicine (A.J.R.) and Pediatrics (A.J.R.), University of Michigan Medical Center and University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Pediatrics (D.M.J., J.C.L.), St. Louis Children's Hospital (D.M.J., J.R.L., J.C.L.) and Washington University School of Medicine, St. Louis, Missouri; Department of Pediatrics (C.S.O.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Neurosurgery (J.R.L.), Division of Emergency Medicine (L.E.N.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Departments of Emergency Medicine (N.K.) and Pediatrics(N.K.), University of California, Davis, School of Medicine, Davis, California.
authors.forename: Prashant
authors.initials: P
authors.lastname: Mahajan
authors.forename: David M
authors.initials: DM
authors.lastname: Jaffe
authors.forename: Cody S
authors.initials: CS
authors.lastname: Olsen
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Leonard
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Rogers
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.forename: Julie C
authors.initials: JC
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002574:Cervical Vertebrae; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017678:Sex Distribution; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000453:epidemiology; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology