{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:54:19Z","timestamp":1791597259129,"version":"4.3.4"},"reference-count":69,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Among the spectrum of spinal injuries, Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) occupies a unique and challenging position. SCIWORA presents diagnostic and therapeutic challenges due to its broad clinical and radiological heterogeneity. While most children recover favorably with conservative treatment, a subset may require surgery based on imaging findings. The findings underscore the need for standardized diagnostic criteria, MRI-based classification systems, and evidence-based treatment algorithms to improve consistency in care and long-term neurological outcomes. Methods: A systematic search of PubMed, Cochrane, Scopus, and Embase databases was performed through June 2025 following PRISMA guidelines. Inclusion criteria encompassed studies of pediatric SCIWORA (age &lt; 18 years) reporting demographics, clinical and radiological features, management, and outcomes. Results: Sixty studies encompassing a total of 848 pediatric patients were included. The mean patient age was 9.33 years (\u00b12.52), with a slight male predominance. The most common trauma mechanisms were road traffic accidents (40.3%), sports injuries (22%), and falls (18.8%). MRI findings were available in 399 cases: 46% had intraneural lesions (Type IIb), 39% showed no abnormality on MRI (Type I, or \u201creal SCIWORA\u201d), 9% had combined lesions (Type IIc), and 6% had extraneural abnormalities (Type IIa). Neurological severity at presentation was primarily ASIA Grade A (46.25%), but follow-up data showed substantial improvement, with ASIA E (normal function) increasing to 49.78%. Overall, 66.2% of patients experienced neurological improvement, while 33.8% remained stable. Conservative treatment was employed in 95.41% of cases. Only 4.59% underwent surgery, which was typically reserved for MRI-positive lesions demonstrating spinal instability or compression. Conclusions: Pediatric SCIWORA remains an uncommon but potentially devastating injury, with an outcome highly dependent on MRI findings and initial neurological status. This systematic review aims to clarify the contemporary understanding of pediatric SCIWORA, delineating \u201creal\u201d SCIWORA from other SCIWORA-like entities, and synthesizing the latest evidence regarding epidemiology, mechanisms, clinical presentation, MRI findings, and management in children.<\/jats:p>","DOI":"10.3390\/jcm14176338","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T08:43:54Z","timestamp":1757493834000},"page":"6338","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Redefining Pediatric SCIWORA: A Systematic Review of the Literature on Clinical Patterns, Imaging Profiles, and Management Insights"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0113-8852","authenticated-orcid":false,"given":"Davide","family":"Palombi","sequence":"first","affiliation":[{"name":"Department of Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"},{"name":"Department of Neuroscience, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4020-8883","authenticated-orcid":false,"given":"Marco","family":"Galeazzi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"},{"name":"Department of Neuroscience, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8163-3787","authenticated-orcid":false,"given":"Paolo","family":"Brigato","sequence":"additional","affiliation":[{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy"},{"name":"Orthopedic Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-3638","authenticated-orcid":false,"given":"Sergio","family":"De Salvatore","sequence":"additional","affiliation":[{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy"},{"name":"Orthopedic Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timoth\u00e9e","family":"De Saint Denis","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedic and Reconstructive Surgery, Armand Trousseau Hospital, AP-HP, Sorbonne University, 75012 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3088-0822","authenticated-orcid":false,"given":"Luca","family":"Massimi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"},{"name":"Department of Neuroscience, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpiero","family":"Tamburrini","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"},{"name":"Department of Neuroscience, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6933-0321","authenticated-orcid":false,"given":"Leonardo","family":"Oggiano","sequence":"additional","affiliation":[{"name":"Orthopedic Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.3171\/jns.1982.57.1.0114","article-title":"Spinal Cord Injury Without Radiographic Abnormalities in Children","volume":"57","author":"Pang","year":"1982","journal-title":"J. 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