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Published in: BMC Pediatrics 1/2019

Open Access 01-12-2019 | Magnetic Resonance Imaging | Case report

Real spinal cord injury without radiologic abnormality in pediatric patient with tight filum terminale following minor trauma: a case report

Authors: Qin Chuan Liang, Bo Yang, Yun Hai Song, Pin Pin Gao, Ze Yang Xia, Nan Bao

Published in: BMC Pediatrics | Issue 1/2019

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Abstract

Background

Spinal cord injury without radiographic abnormality (SCIWORA) is defined as having “clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability”. The mechanism of pediatric SCIWORA following minor trauma is still unclear. Tight filum terminale (TFT) has been studied in the literature, but the information regarding the predisposing factor for SCIWORA is still being defined.

Case presentation

We report three cases of thoracic and lumber SCIWORA with TFT. The trauma was potentially mild in all cases but resulted in catastrophic damage of the cord. All patients had no signs or symptoms of tethered cord syndrome prior to the minor trauma. TFT was found during operation.

Conclusions

We suggest that TFT might be a predisposing factor for SCIWORA and chronic spinal cord traction play an important role in the mechanism of pediatric thoracic and lumber SCIWORA following minor trauma. Patients who never undergo treatment for TFT likely have an elevated risk of developing SCIWORA following minor trauma.
Literature
1.
go back to reference Pang D, Wilberger JE Jr. Spinal cord injury without radiographic abnormalities in children. J Neurosurg. 1982;57(1):114–29.CrossRef Pang D, Wilberger JE Jr. Spinal cord injury without radiographic abnormalities in children. J Neurosurg. 1982;57(1):114–29.CrossRef
2.
go back to reference Szwedowski D, Walecki J. Spinal cord injury without radiographic abnormality (SCIWORA) - clinical and radiological aspects. Pol J Radiol. 2014;79:461–4.CrossRef Szwedowski D, Walecki J. Spinal cord injury without radiographic abnormality (SCIWORA) - clinical and radiological aspects. Pol J Radiol. 2014;79:461–4.CrossRef
3.
go back to reference Hendey GW, Wolfson AB, Mower WR, Hoffman JR, National Emergency XRUSG. Spinal cord injury without radiographic abnormality: results of the National Emergency X-radiography utilization study in blunt cervical trauma. J Trauma. 2002;53(1):1–4.CrossRef Hendey GW, Wolfson AB, Mower WR, Hoffman JR, National Emergency XRUSG. Spinal cord injury without radiographic abnormality: results of the National Emergency X-radiography utilization study in blunt cervical trauma. J Trauma. 2002;53(1):1–4.CrossRef
4.
go back to reference Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 2004;55(6):1325–42 discussion 1342-1323.CrossRef Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 2004;55(6):1325–42 discussion 1342-1323.CrossRef
5.
go back to reference Saker E, Henry BM, Tomaszewski KA, Loukas M, Iwanaga J, Oskouian RJ, Tubbs RS. The filum terminale internum and externum: a comprehensive review. J Clin Neurosci. 2017;40:6–13.CrossRef Saker E, Henry BM, Tomaszewski KA, Loukas M, Iwanaga J, Oskouian RJ, Tubbs RS. The filum terminale internum and externum: a comprehensive review. J Clin Neurosci. 2017;40:6–13.CrossRef
6.
go back to reference Bhimani AD, Selner AN, Patel JB, Hobbs JG, Esfahani DR, Behbahani M, Zayyad Z, Nikas D, Mehta AI. Pediatric tethered cord release: an epidemiological and postoperative complication analysis. J Spine Surg. 2019;5(3):337–50.CrossRef Bhimani AD, Selner AN, Patel JB, Hobbs JG, Esfahani DR, Behbahani M, Zayyad Z, Nikas D, Mehta AI. Pediatric tethered cord release: an epidemiological and postoperative complication analysis. J Spine Surg. 2019;5(3):337–50.CrossRef
7.
go back to reference Carroll T, Smith CD, Liu X, Bonaventura B, Mann N, Liu J, Ebraheim NA. Spinal cord injuries without radiologic abnormality in children: a systematic review. Spinal Cord. 2015;53(12):842–8.CrossRef Carroll T, Smith CD, Liu X, Bonaventura B, Mann N, Liu J, Ebraheim NA. Spinal cord injuries without radiologic abnormality in children: a systematic review. Spinal Cord. 2015;53(12):842–8.CrossRef
8.
go back to reference Yamada S, Won DJ. What is the true tethered cord syndrome? Childs Nerv Syst. 2007;23(4):371–5.CrossRef Yamada S, Won DJ. What is the true tethered cord syndrome? Childs Nerv Syst. 2007;23(4):371–5.CrossRef
9.
go back to reference Usami K, Lallemant P, Roujeau T, James S, Beccaria K, Levy R, Di Rocco F, Sainte-Rose C, Zerah M. Spinal lipoma of the filum terminale: review of 174 consecutive patients. Childs Nerv Syst. 2016;32(7):1265–72.CrossRef Usami K, Lallemant P, Roujeau T, James S, Beccaria K, Levy R, Di Rocco F, Sainte-Rose C, Zerah M. Spinal lipoma of the filum terminale: review of 174 consecutive patients. Childs Nerv Syst. 2016;32(7):1265–72.CrossRef
10.
go back to reference Kashlan ON, Wilkinson DA, Morgenstern H, Khalsa SS, Maher CO. Predictors of surgical treatment in children with tethered fibrofatty filum terminale. J Neurosurg Pediatr. 2019:1–8. Kashlan ON, Wilkinson DA, Morgenstern H, Khalsa SS, Maher CO. Predictors of surgical treatment in children with tethered fibrofatty filum terminale. J Neurosurg Pediatr. 2019:1–8.
11.
go back to reference O'Neill BR, Gallegos D, Herron A, Palmer C, Stence NV, Hankinson TC, Corbett Wilkinson C, Handler MH. Use of magnetic resonance imaging to detect occult spinal dysraphism in infants. J Neurosurg Pediatr. 2017;19(2):217–26.CrossRef O'Neill BR, Gallegos D, Herron A, Palmer C, Stence NV, Hankinson TC, Corbett Wilkinson C, Handler MH. Use of magnetic resonance imaging to detect occult spinal dysraphism in infants. J Neurosurg Pediatr. 2017;19(2):217–26.CrossRef
12.
go back to reference Gupta A, Rajshekhar V. Fatty filum terminale (FFT) as a secondary tethering element in children with closed spinal dysraphism. Childs Nerv Syst. 2018;34(5):925–32.CrossRef Gupta A, Rajshekhar V. Fatty filum terminale (FFT) as a secondary tethering element in children with closed spinal dysraphism. Childs Nerv Syst. 2018;34(5):925–32.CrossRef
13.
go back to reference Yamada S, Won DJ, Pezeshkpour G, Yamada BS, Yamada SM, Siddiqi J, Zouros A, Colohan AR. Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg Focus. 2007;23(2):E6.CrossRef Yamada S, Won DJ, Pezeshkpour G, Yamada BS, Yamada SM, Siddiqi J, Zouros A, Colohan AR. Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg Focus. 2007;23(2):E6.CrossRef
14.
go back to reference Tu A, Steinbok P. Occult tethered cord syndrome: a review. Childs Nerv Syst. 2013;29(9):1635–40.CrossRef Tu A, Steinbok P. Occult tethered cord syndrome: a review. Childs Nerv Syst. 2013;29(9):1635–40.CrossRef
15.
go back to reference Paleologos TS, Fratzoglou MM, Papadopoulos SS, Chatzidakis EE, Gouliamos AD, Kourousis DD. Posttraumatic spinal cord lesions without skeletal or discal and ligamentous abnormalities: the role of MR imaging. J Spinal Disord. 1998;11(4):346–9.PubMed Paleologos TS, Fratzoglou MM, Papadopoulos SS, Chatzidakis EE, Gouliamos AD, Kourousis DD. Posttraumatic spinal cord lesions without skeletal or discal and ligamentous abnormalities: the role of MR imaging. J Spinal Disord. 1998;11(4):346–9.PubMed
16.
go back to reference Tani S, Yamada S, Knighton RS. Extensibility of the lumbar and sacral cord. Pathophysiology of the tethered spinal cord in cats. J Neurosurg. 1987;66(1):116–23.CrossRef Tani S, Yamada S, Knighton RS. Extensibility of the lumbar and sacral cord. Pathophysiology of the tethered spinal cord in cats. J Neurosurg. 1987;66(1):116–23.CrossRef
17.
go back to reference Ren J, Zeng G, Ma YJ, Chen N, Chen Z, Ling F, Zhang HQ. Pediatric thoracic SCIWORA after back bend during dance practice: a retrospective case series and analysis of trauma mechanisms. Childs Nerv Syst. 2017;33(7):1191–8.CrossRef Ren J, Zeng G, Ma YJ, Chen N, Chen Z, Ling F, Zhang HQ. Pediatric thoracic SCIWORA after back bend during dance practice: a retrospective case series and analysis of trauma mechanisms. Childs Nerv Syst. 2017;33(7):1191–8.CrossRef
18.
go back to reference Wang YJ, Zhou HJ, Wei B, Liu GL, Zheng Y, Zhang Y, Hao CX, Kang HQ, Yuan Y, Lu XL. Clinical characteristics analysis of 120 cases of pediatric spinal cord injury without radiologic abnormality. Zhonghua Yi Xue Za Zhi. 2016;96(2):122–5.PubMed Wang YJ, Zhou HJ, Wei B, Liu GL, Zheng Y, Zhang Y, Hao CX, Kang HQ, Yuan Y, Lu XL. Clinical characteristics analysis of 120 cases of pediatric spinal cord injury without radiologic abnormality. Zhonghua Yi Xue Za Zhi. 2016;96(2):122–5.PubMed
19.
go back to reference Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg. 1954;11(6):546–77.CrossRef Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg. 1954;11(6):546–77.CrossRef
Metadata
Title
Real spinal cord injury without radiologic abnormality in pediatric patient with tight filum terminale following minor trauma: a case report
Authors
Qin Chuan Liang
Bo Yang
Yun Hai Song
Pin Pin Gao
Ze Yang Xia
Nan Bao
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2019
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-019-1894-8

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