SCIWORA

Normal MRI, patients with MRI that shows purely neural damage (e.g. cord oedema or haemorrhage) but no extra-neural lesion (e.g. disc prolapse or compressive haematoma) are also included within this definition.

Objective signs of myelopathy as a result of trauma in the absence of any radiographically evident fracture, dislocation, or ligamentous instability (on static or dynamic X-rays or CT).

Children with a history of transient neurological signs or symptoms referable to the spinal cord after a traumatic event but normal neurological examination can develop delayed onset SCIWORA

If paraspinous muscle spasm, pain, or un-cooperation prevents dynamic studies, they recommended external immobilization until the child can cooperatively flex and extend the spine for dynamic X-ray assessment.
Although concern exists for the late development of pathological intersegmental motion in children with SCIWORA following normal flexion and extension studies, there has been no documentation of such instability ever developing.
Neither spinal angiography nor myelography is recommended in the evaluation of patients with SCIWORA.

signal change
intramedullary injury (prognostic value),
excluding compressive lesions of the cord/roots needing surgery,
exclude spinal ligamentous disruption that might warrant surgical intervention (in situations where dynamic flexion/extension radiographs cannot be done or would be superfluous preoperatively),
guiding treatment regarding length of external immobilization (e.g. evidence of residual ligamentous injury),
determining when to allow patients to return to full activity.

detect subtle posterior column dysfunction when clinical findings are inconclusive,
evaluating head-injured, comatose, or pharmacologically paralyzed children,
distinguishing between intracranial, spinal, or peripheral nerve injuries, and/or providing a baseline for comparison with subsequent evaluations.

that may either lead to exacerbation of the present (ligamentous and spina cord) strain/injury or increase the potential for recurrent injury.
Treatment consisting of cervicothoracic bracing for patients with cervical-level SCIWORA for 12 weeks and avoidance of activities that encourage flexion and extension of the neck for an additional 12 weeks (i.e. 6 months total) has not been associated with recurrent injury.
Patients with normal MRI and SSEP findings following transient deficits or “symptoms only” may be managed with a cervical collar for 1-2 weeks.

It could be that the paediatric spine is so flexible that even physiological flexion and extension can damage the injured spinal cord