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Vertebral Compression Injuries Vertebral compression injuries are most frequently caused by axial loading and hyperflexion They are suggested by isolated anterior wedging, teardrop fractures, or burst vertebral bodies ( Fig 112.29 ) The vertebral bodies should be regular, cuboid, and consistent between adjacent cervical levels ( Fig 112.29 ) A flexion/rotation stress can lead to anterior subluxation of one vertebral body on another with facet dislocation (“locked” or “jumped” facet) ( Fig 112.30 ) If the anterior displacement is less than 50% of the vertebral body width, it is consistent with a unilateral facet dislocation ( Fig 112.30 ) More than a 50% anterior subluxation suggests a bilateral facet dislocation ( Fig 112.30 ) These injuries are often accompanied by widened interspinous and interlaminar spaces, anterior soft tissue swelling, and a narrowed disc space Spinal Cord Injury Without Radiographic Abnormality SCIWORA was initially described as occurring in up to 67% of all children with cervical cord injuries ( Fig 112.31 ), and up to 25% of cervical cord injuries in children younger than years SCIWORA has been described as mainly occurring in children younger than years who present with, or develop symptoms consistent with, cervical cord injuries without any radiographic or tomographic evidence of bony abnormality Some authors have recently suggested that the diagnosis of SCIWORA be applied only to those patients who also not have abnormal MRI findings The original characterization of this syndrome occurred during a period when MRI was less available and it is important to note there are distinct differences between patients with and without MRI findings in the setting of persistent neurologic abnormalities Regardless, this type of injury is not often seen in children older than years because the forces necessary to injure the spinal cord also cause persistent spinal column abnormalities In older children, sports-related injuries have been found to have a higher association with SCIWORA (OR 3.5) as compared to those injured by other mechanisms The young child’s elastic spinal column, ligamentous laxity, horizontal facets, and underdeveloped spinous processes allow the spine to deform beyond physiologic extremes, injuring the cord, and then reducing spontaneously without any persistent (radiographic) evidence of bone injury The causes of the neurologic compromise can include segmental spinal instability, vascular injury (occlusion, spasm, and infarction), ligamentous injury, disc impingement, or incomplete neuronal destruction A subset of patients has initial transient neurologic symptoms as previously described, temporarily recover, and then return, on average, day later with neurologic abnormalities Therefore, hospitalization, immobilization, and further radiographic evaluation (MRI) for this group of
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