SCIWORA (SPINAL-CORD INJURY WITHOUT RADIOGRAPHIC ABNORMALITY) IN INFANTS AND CHILDREN

We review the biomechanics of the pediatric cervical spine and the cli nical findings that pertain to SCIWORA (spinal cord injury without rad iographic abnormality) in order to provide a more thorough understandi ng of this pediatric phenomenon of closed spinal trauma with significa nt neurologic sequelae but without bony injury. The unique hypermobili ty and ligamentous laxity of the pediatric bony cervical and thoracic spine predispose to a SCIWORA-type injury. in SCIWORA, the unusually e lastic biomechanics of the pediatric bony spine allow deformation of t he musculoskeletal structures beyond physiologic extremes, permitting direct cord trauma followed by spontaneous reduction of the bony spine , Potential mechanisms of the SCIWORA include hyperextension/flexion, longitudinal distraction, and ischemic injury of the spinal cord.