Absence of MRI soft tissue abnormalities in severe spinal cord injury in children: Case-based update

Introduction Occult spinal cord injury should be suspected based not only on the mechanism of trauma but also on the age of the patient. The pediatric spine has unique biomechanical and anatomical properties that must be considered carefully when evaluating spinal cord trauma. For instance, the hypermobility and elasticity of the spinal column in children often lead to self-reducing injuries that can mask spinal cord injury. Case illustration We present the case of a 22-month-old male patient who was found to have ligamentous injury detected by magnetic resonance imaging (MRI) in the upper cervical spine but missed by MRI in the lower thoracic spine. Furthermore, there was no spinal cord injury in the upper cervical spine, but indeed a serious insult in the thoracic region. Since the advent of MRI, spinal cord injury without radiographic abnormality (SCIWORA) has become increasingly rare but not altogether extinct. Conclusions We present a noteworthy example of the inadequacy of MRI in revealing SCIWORA, a term that is antiquated as we combine the latest imaging techniques with a better understanding of the biomechanics of trauma and spine injury. Based on the literature and our case illustration, we believe that the biomechanics of the pediatric spine must be considered when children who may have sustained a SCIWORA are examined.