Abstract
Purpose of study:
The question of prolonged bracing following injury in patients diagnosed with SCIWORA remains controversial. Proponents of the ‘Segmental Spinal Instability’ hypothesis claim that there is occult ligamentous injury leading to instability and a risk of recurrent injury. Published reports of recurrent SCIWORA involve patients with minor, transient neurological symptoms and normal MRI findings. The contradicting ‘differential stretch hypothesis’ is based on the premise that the spinal column will deform elastically, exceeding the elastic deforming potential of the more fragile spinal cord, but will return to its baseline stability. The purpose of this study is to evaluate the need for bracing in patients with SCIWORA based on MRI evidence of instability.
Methods:
A retrospective chart review was performed for a series of eleven patients with documented SCIWORA that presented to Red Cross Children's Hospital over the past 8 years. Details regarding mode of injury, age at presentation, neurological deficit at presentation, MRI findings and long term prognosis were documented. MRI's were reviewed by the authors as well as a consultant radiologist.
Results:
There were 9 males and 2 females. The average age was 4.5 years. All patients were victims of motor vehicle accidents and had multiple injuries.
Five patients had cervical, five thoracic and one had both cervical and thoracic injuries. There were 1 monoplegia, 4 hemiplegias, 3 paraplegias and 3 triplegias.
None of the MRIs performed on these patients demonstrated ligamentous or bony injury.
Patients with only T2 changes demonstrated progressive neurological recovery within a few months following injury. There were no recurrences and none of the patients were braced following the diagnosis of SCIWORA.
Conclusion:
Our results from this small series support the ‘differential stretch hypothesis’ and we maintain that patient's with SCIWORA does not demonstrate spinal instability and therefore does not require bracing following injury.
