Pediatric XXXX without radiographic abnormality (SCIWORA): the absence of occult instability and lack of indication for bracing.

@entity1 @entity3510 @entity174 @entity209 @entity16 @entity281 @entity51 @entity911 @entity1566 @entity130 @entity3029
STUDY DESIGN: A retrospective review of medical records and imaging studies of @entity1 diagnosed with @entity1566 without radiographic abnormality (SCIWORA) or SCIWORA-like symptoms at @entity1 's Hospital of Pittsburgh between 1965 and 1999 was undertaken. OBJECTIVES: To evaluate the existence of occult segmental spinal instability and a role for bracing as treatment for SCIWORA, we contrasted the @entity1 's Hospital of Pittsburgh experience with literature reports on SCIWORA. SUMMARY OF BACKGROUND DATA: There is a great deal of @entity911 and conflicting evidence regarding pediatric SCIWORA in the literature. Previous reports from our institution reported unique findings, including the only description of serious, recurrent SCIWORA in the literature. These findings have frequently been cited as the justification for long-term immobilization in all cases of SCIWORA. METHODS: All records on @entity1 coded as @entity1566 without @entity174 or @entity3029 (ICD-9 code 952.xx) were reviewed. @entity1 17 years of age or younger with traumatic @entity1566 and normal plain radiographic findings were included. Penetrating @entity130 , @entity281 , or @entity209 were excluded. RESULTS: A total of 189 @entity1 were diagnosed with SCIWORA at our institution over the 35-year review period. These @entity1 differed from those reported in the literature with respect to a higher incidence, older age, less involved @entity16 , and more low-energy mechanisms, such as sports and falls. There were no cases of a @entity1 with SCIWORA who deteriorated and developed a permanent @entity51 after having either recovered or plateaued from an initial SCIWORA. All recurrent SCIWORA recovered to normal neurologic function. Bracing did not demonstrate any benefit in preventing these minor recurrent SCIWORAs. CONCLUSION: We identified no cases of serious, recurrent SCIWORA at our institution from 1965 to 1999. A case-by-case evaluation is required for the treatment of @entity1566 without apparent @entity3510 , and bracing is not uniformly indicated.
