Redefining Pediatric SCIWORA: A Systematic Review of the Literature on Clinical Patterns, Imaging Profiles, and Management Insights
Abstract
1. Introduction
2. Materials and Methods
2.1. Search Strategy and Eligibility Criteria
2.2. Data Collection Process
2.3. Risk of Bias Assessment
2.4. Data Extraction and Synthesis
2.5. Data Analysis
3. Results
3.1. Study Selection
3.2. Risk of Bias Assessment Results
3.3. Study Characteristics and Population Overview
3.4. Trauma Mechanisms and MRI Findings
3.5. Neurological Outcomes
3.6. Conservative Management and Surgical Treatment
4. Discussion
4.1. Mechanisms of Trauma, Clinical Presentation, and MRI
4.2. ASIA Outcomes, Neurological Improvement Rates, and Comparative Analysis
4.3. Lack of Consensus and General Management Approaches
4.4. Study Limitations and Future Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
SCIWORA | Spinal Cord Injury Without Radiographic Abnormality |
MRI | Magnetic Resonance Imaging |
CT | Computed Tomography |
ASIA | American Spinal Injury association Impairment Scale |
RTA | Road Traffic Accident |
CNS | Central Nervous System |
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Authors | Year | N. | Age | Sex | Trauma Mechanism | MRI Type | Onset | Therapy | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Male | Female | Sport | Fall | RTA | Other | I | IIa | IIb | IIc | ||||||
Pollack et al. [5] | 1988 | 1 | 9 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | NA | NA |
Matsumara et al. [2] | 1990 | 1 | 3 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | + | C |
Riviello et al. [6] | 1990 | 2 | 2.5 | 0 | 2 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 0 | + | C |
Dickman et al. [15] | 1991 | 26 | 10.5 | 19 | 7 | 7 | 7 | 12 | 0 | 5 | 0 | 2 | 1 | NA | NA |
Meuli et al. [16] | 1991 | 1 | 5.3 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | NA | C |
Ferguson et al. [26] | 1993 | 1 | 2 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | − | C |
Bondurant et al. [8] | 1993 | 1 | 2.3 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | NA | C |
Grabb et al. [9] | 1994 | 7 | 7.4 | 5 | 2 | 0 | 0 | 1 | 2 | 1 | 2 | 3 | 1 | NA | C |
Felsberg et al. [27] | 1995 | 12 | 9 | 8 | 4 | 1 | 0 | 9 | 0 | 7 | 0 | 3 | 2 | NA | NA |
Duprez et al. [10] | 1998 | 1 | 2 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | + | NA |
Pollina et al. [17] | 1999 | 1 | 3 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | NA | C |
Trumble et al. [7] | 2000 | 1 | 3 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | + | C |
Beck et al. [3] | 2000 | 1 | 16 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | NA | C |
Koestner et al. [28] | 2001 | 1 | 1.4 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | + | C |
Boockvar et al. [11] | 2001 | 13 | 11.5 | 9 | 4 | 13 | 0 | 0 | 0 | 13 | 0 | 0 | 0 | NA | C |
Mortazavi et al. [29] | 2001 | 1 | 1.8 | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | NA | C |
Yamaguchi et al. [12] | 2002 | 1 | 14 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | + | C |
Dare et al. [30] | 2002 | 19 | 12.1 | 16 | 3 | 11 | 0 | 3 | 0 | 17 | 0 | 2 | 0 | NA | C |
Bosch et al. [4] | 2002 | 9 | 5.7 | 6 | 3 | 0 | 2 | 5 | 2 | 0 | 1 | 8 | 0 | + | C |
Ergun et al. [31] | 2003 | 1 | 12 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 0 | NA | C |
Liao et al. [32] | 2005 | 9 | 4.1 | 6 | 3 | 0 | 4 | 5 | 0 | 3 | 0 | 6 | 0 | NA | C |
Lee et al. [33] | 2006 | 1 | 1.2 | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | + | C |
Buldini et al. [18] | 2006 | 2 | 5.7 | 1 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | + | C |
Dickerman et al. [34] | 2006 | 1 | 14 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | + | C |
Kalra et al. [19] | 2006 | 1 | 2.5 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | + | C |
Rich et al. [35] | 2006 | 1 | 5 | \ | 0 | \ | 0 | 0 | 0 | 0 | 1 | 0 | 0 | − | S |
Fregeville et al. [13] | 2007 | 1 | 14 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | − | C |
Shen et al. [36] | 2007 | 1 | 6 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | NA | C |
Kim et al. [23] | 2008 | 1 | 1 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | + | C |
Feldman et al. [37] | 2008 | 2 | 0.3 | 0 | 2 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | + | C |
Elmagal et al. [38] | 2008 | 2 | 9 | 2 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 2 | 0 | − | S |
Grubenhoff et al. [20] | 2008 | 1 | 7 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | NA | C |
Silman et al. [39] | 2008 | 1 | 0.9 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | − | C |
Sullivan et al. [40] | 2008 | 2 | 6 | 2 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | + | C |
Triglylidas et al. [41] | 2010 | 3 | 11.3 | 2 | 1 | 1 | 0 | 2 | 0 | 0 | 1 | 2 | 0 | NA | C |
Yalcin et al. [22] | 2011 | 3 | 3.9 | 2 | 2 | 0 | 0 | 3 | 0 | 2 | 0 | 0 | 1 | NA | 2 C; 1 S |
Snoek et al. [42] | 2012 | 1 | 5 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | − | S |
Abbo et al. [43] | 2013 | 2 | 1.8 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 2 | 0 | + | S |
Phillips et al. [44] | 2013 | 2 | 2 | 2 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 1 | 1 | − | C |
Mahajan et al. [45] | 2013 | 69 | 11.1 | 52 | 17 | 27 | 18 | 8 | 16 | 54 | 0 | 15 | 0 | NA | 66 C, 3 S |
Ayaz et al. [46] | 2014 | 1 | 3.5 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | − | C |
Fiaschi et al. [47] | 2016 | 1 | 1.3 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | + | S |
Knox et al. [48] | 2016 | 297 | 10.66 | 191 | 106 | 122 | 41 | 76 | 58 | Na | NA | NA | NA | NA | 291 C, 6 S |
Kim et al. [49] | 2016 | 2 | 13.5 | 2 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 2 | + | C |
Bansal et al. [24] | 2016 | 1 | 0.8 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | + | C |
Nagasawa et al. [50] | 2017 | 1 | 13 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | − | C |
Jian et al. [51] | 2017 | 12 | 6.6 | 0 | 12 | 12 | 0 | 0 | 0 | 0 | 10 | 0 | 2 | + | C |
Campbell et al. [52] | 2018 | 1 | 2 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | − | C |
Liang et al. [53] | 2019 | 3 | 6.3 | 1 | 2 | 0 | 0 | 0 | 3 | 0 | 0 | 0 | 3 | − | S |
Bansal et al. [54] | 2020 | 13 | 11 | NA | NA | Na | NA | NA | NA | NA | NA | NA | NA | NA | NA |
Brauge et al. [55] | 2020 | 30 | 9.7 | 23 | 7 | NA | NA | NA | NA | 8 | 1 | 20 | 1 | NA | 29 C; 1 S |
Kim et al. [56] | 2021 | 1 | 7 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | − | C |
Butts et al. [57] | 2021 | 1 | 11 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | − | C |
Liang et al. [53] | 2022 | 16 | 6.3 | 1 | 15 | 12 | 4 | 0 | 0 | 1 | 0 | 15 | 0 | − | C |
Garcia-Cabra et al. [58] | 2021 | 1 | 16 | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | − | C |
Freigang et al. [59] | 2022 | 32 | 14.5 | 21 | 11 | 8 | 14 | 6 | 4 | 32 | 0 | 0 | 0 | NA | C |
Zou et al. [21] | 2023 | 140 | 7.72 | 42 | 98 | 61 | 40 | 15 | 24 | NA | NA | NA | NA | NA | C |
Liu et al. [60] | 2024 | 47 | 7.49 | 16 | 31 | 31 | 2 | 9 | 5 | 4 | 0 | 43 | 0 | 41−; 6+ | 1 S, 46 C |
Hu et al. [61] | 2024 | 39 | 7.2 | 3 | 36 | 25 | 10 | 4 | 0 | 1 | 6 | 34 | 6 | NA | NA |
Romero-Munoz et al. [62] | 2024 | 13 | 4 | 10 | 3 | 1 | 1 | 10 | 1 | 2 | 0 | 7 | 4 | 12−/1+ | 12 C; 1 S |
Total | 848 | 9.33 ± 2.52 | 458 | 388 | 342 | 159 | 187 | 117 | 157 | 24 | 182 | 36 | 801 C, 39 S, 8 NA |
Authors | Year | N. | Location | Worst ASIA | ASIA Final FUP | % of Improvement | % of Stability |
---|---|---|---|---|---|---|---|
Pollack et al. [5] | 1988 | 1 | 1 CT | C | E | 100% | 0% |
Matsumara et al. [2] | 1990 | 1 | 1 CT | A | A | 0% | 100% |
Riviello et al. [6] | 1990 | 2 | 1 C 1 CT | 2 B | 1 C 1 D | 100% | 0% |
Dickman et al. [15] | 1991 | 26 | 18 C 8 T | 7 A 2 B 5 C 12 D 0 E | 2 A 0 B 2 C 3 D 17 E 2 Died | 80% | 20% |
Meuli et al. [16] | 1991 | 1 | 1 T | C | E | 100% | 0% |
Ferguson et al. [26] | 1993 | 1 | 1 T | A | A | 0% | 100% |
Bondurant et al. [8] | 1993 | 1 | 1 C | B | C | 100% | 0% |
Duprez et al. [10] | 1998 | 1 | 1 CT | A | A | 100% | 0% |
Pollina et al. [17] | 1999 | 1 | 1 T | A | A | 0% | 100% |
Trumble et al. [7] | 2000 | 1 | 1 T | A | A | 0% | 100% |
Beck et al. [3] | 2000 | 1 | 1 C | A | E | 100% | 0% |
Koestner et al. [28] | 2001 | 1 | 1 High C | B | B | 0% | 100% |
Boockvar et al. [11] | 2001 | 13 | 1 C | 7 C 5 D | 13 E | 100% | 0% |
Mortazavi et al. [29] | 2001 | 1 | 1 T | B | B | 0% | 100% |
Yamaguchi et al. [12] | 2002 | 1 | 1 T | B | D | 100% | 0% |
Dare et al. [30] | 2002 | 19 | NA | 2 A 0 B 1 C 16 D 0 E | 1 A 1 B 0 C 2 D 15 E | 95% | 5% |
Bosch et al. [4] | 2002 | 9 | NA | 5 A 1 B 1 C 1 D 1 E | 5 A 1 B 1 C 2 E | 11% | 88% |
Ergun et al. [31] | 2003 | 1 | 1 CT | A | C | 100% | 0% |
Liao et al. [32] | 2005 | 9 | 2 C 2 CT 5 T | 3 A 1 B 2 C 3 D | 2 A 3 C 1 D 3 E | 66% | 33% |
Lee et al. [33] | 2006 | 1 | None | C | E | 100% | 0% |
Buldini et al. [18] | 2006 | 2 | 1 CT 1 T | 2 A | A, C | 50% | 50% |
Dickerman et al. [34] | 2006 | 1 | 1 C | C | E | 100% | 0% |
Kalra et al. [19] | 2006 | 1 | 1 C | A | A | 0% | 100% |
Rich et al. [35] | 2006 | \ | 1 C | D | E | 100% | 0% |
Fregeville et al. [13] | 2007 | 1 | 1 High C | A | C | 100% | 0% |
Shen et al. [36] | 2007 | 1 | T | C | D | 100% | 0% |
Kim et al. [23] | 2008 | 1 | 1 Low C | C | D | 100% | 0% |
Feldman et al. [37] | 2008 | 2 | 2 C | 1 A 1 C | 1 A 1 E | 50% | 50% |
Elmagal et al. [38] | 2008 | 1 | 1 C | A | A | 50% | 50% |
Grubenhoff et al. [20] | 2008 | 1 | 1 C | B | C | 100% | 0% |
Silman et al. [39] | 2008 | 1 | 1 CT | A | A | 0% | 100% |
Sullivan et al. [40] | 2008 | 2 | 1 C 1 T | A D | A E | 50% | 50% |
Triglylidas et al. [41] | 2010 | 3 | 1 C 2 T | 2 A 1 D | 2 A 1 E | 33% | 66% |
Yalcin et al. [22] | 2011 | 3 | 3 T 1 L | 2 A 1 B | 1 A 2 C | 66% | 33% |
Snoek et al. [42] | 2012 | 1 | 1 C | B | E | 100% | 0% |
Abbo et al. [43] | 2013 | 2 | 1 CT, 1 TL | 2 A | 1 C, 1 E | 100% | 0% |
Phillips et al. [44] | 2013 | 2 | 1 T, 1 CT | 2 A | 1 A, 1 B | 50% | 50% |
Mahajan et al. [45] | 2013 | 69 | 69 C | NA | NA | NA | NA |
Ayaz et al. [46] | 2014 | 1 | 1 T | A | C | 100% | 0% |
Fiaschi et al. [47] | 2016 | 1 | 1 High C | E | E | 0% | 100% |
Knox et al. [48] | 2016 | 297 | 137 C 41 T 21 L 1 S 150 NA | NA | NA | NA | NA |
Kim et al. [49] | 2016 | 2 | 1 Low CA 1 T | 1 A 1 D | 1 A 1 E | 50% | 50% |
Bansal et al. [24] | 2016 | 1 | 1 C | A | C | 100% | 0% |
Nagasawa et al. [50] | 2017 | 1 | 1 C | D | E | 100% | 0% |
Jian et al. [51] | 2017 | 12 | 5 T 6 TL 1 CT | 10 A 2 B | 7 A 2 B 2 C 0 D 1 E | 41.60% | 58.40% |
Campbell et al. [52] | 2018 | 1 | 1 T | A | A | 0% | 100% |
Liang et al. [53] | 2019 | 3 | 2 TL, 1 T | 3 A | 3 A | 0% | 100% |
Bansal et al. [54] | 2020 | 13 | 8 T 4 C 1 L | 6 A 1 B 1 D 5 E | NA | NA | NA |
Brauge et al. [55] | 2020 | 30 | 19 C 10 T 1 L | 14 A 3 B 9 C 3 D 1 E | 2 died 5 A 3 B 1 C 19 E | 66.70% | 33.30% |
Kim et al. [56] | 2021 | 1 | 1 High C | C | D | 100% | 0% |
Butts et al. [57] | 2021 | 1 | None | E | E | 0% | 100% |
Liang et al. [53] | 2021 | 16 | 2 CT 14 C | 7 A 3 B 3 C 3 D 0 E | 6 A 0 B 3 C 3 D 4 E | 62.50% | 37.50% |
Garcia-Cabra et al. [58] | 2021 | 1 | 1 C | A | C | 100% | 0% |
Freigang et al. [59] | 2022 | 32 | NA | 6 A 3 B 12 C 11 D 0 E | 32 E | 100% | 0% |
Zou et al. [21] | 2023 | 140 | 14 C | 70 A 24 B 20 C 20 D 1 E 5 NA | NA | NA | NA |
Liu et al. [60] | 2024 | 47 | 9 C 6 CT 22 T 8 TL 2 L | 28 A 13 B 5 C 1 D 0 E | 24 A 12 B 8 C 2 D 1 E | 21.20% | 79.80% |
Hu et al. [61] | 2024 | 39 | 4 C 26 T 9 L | 20 A 5 B 4 C 10 D 0 E | NA | 43.60% | 56% |
Romero-Munoz et al. [62] | 2024 | 13 | 7 C 6 T | 4 A 4 B 4 C 1 D 0 E | 4 A 3 B 2 C 4 D 0 E | 23% | 77% |
Total | 848 | 331 C (58.79%) 155 T (27.53%) 36 L (6.39%) 23 CT (4.08%) 17 TL (3.01%) 1 S (0.17%) | A 210 (46.25%) B 70 (15.41%) C 77 (16.96%) D 87 (19.16%) E 10 (4.54%) | A 56 (24.45%) B 14 (6.11%) C 26 (11.35%) D 19 (8.29%) E 114 (49.78%) | 66.2% | 33.8% |
Author | Year | N. | Type of Lesion | Type of Surgery |
---|---|---|---|---|
Rich et al. [35] | 2006 | 1 | cervical | anterior cervical decompression and fusion using iliac crest bone graft and plate |
Yalcin et al. [22] | 2011 | 1 | Lumbar | Laminectomy |
Snoek et al. [42] | 2012 | 1 | Multiple | Decompression of the spinal cord and fusion of the second and third vertebral bodies (L2–L3) |
Mahajan et al. [45] | 2013 | 3 | Cervical | Internal fixation/halo |
Fiaschi et al. [47] | 2016 | 1 | C1C3 hematomyelia | Occipito-cervical (C1) decompression |
Knox et al. [48] | 2016 | 6 | NA | NA |
Liang et al. [63] | 2019 | 3 | T9L1 with tight filum terminale T12L1 with tight filum terminale T6T10 with tight filum terminale | lysis of the filum terminale lysis of the filum terminale lysis of the filum terminale |
Brauge et al. [55] | 2020 | 1 | Cervical | Surgery for cervical diastemtomyelia |
Liu et al. [60] | 2024 | 1 | NA | NA |
Romero Munoz et al. [62] | 2024 | 1 | Cervical | Laminectomy for posterior decompression |
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Palombi, D.; Galeazzi, M.; Brigato, P.; De Salvatore, S.; De Saint Denis, T.; Massimi, L.; Tamburrini, G.; Oggiano, L. Redefining Pediatric SCIWORA: A Systematic Review of the Literature on Clinical Patterns, Imaging Profiles, and Management Insights. J. Clin. Med. 2025, 14, 6338. https://doi.org/10.3390/jcm14176338
Palombi D, Galeazzi M, Brigato P, De Salvatore S, De Saint Denis T, Massimi L, Tamburrini G, Oggiano L. Redefining Pediatric SCIWORA: A Systematic Review of the Literature on Clinical Patterns, Imaging Profiles, and Management Insights. Journal of Clinical Medicine. 2025; 14(17):6338. https://doi.org/10.3390/jcm14176338
Chicago/Turabian StylePalombi, Davide, Marco Galeazzi, Paolo Brigato, Sergio De Salvatore, Timothée De Saint Denis, Luca Massimi, Gianpiero Tamburrini, and Leonardo Oggiano. 2025. "Redefining Pediatric SCIWORA: A Systematic Review of the Literature on Clinical Patterns, Imaging Profiles, and Management Insights" Journal of Clinical Medicine 14, no. 17: 6338. https://doi.org/10.3390/jcm14176338
APA StylePalombi, D., Galeazzi, M., Brigato, P., De Salvatore, S., De Saint Denis, T., Massimi, L., Tamburrini, G., & Oggiano, L. (2025). Redefining Pediatric SCIWORA: A Systematic Review of the Literature on Clinical Patterns, Imaging Profiles, and Management Insights. Journal of Clinical Medicine, 14(17), 6338. https://doi.org/10.3390/jcm14176338