Tandem spinal cord injuries without radiographic abnormalities in a young child

Anatomic features unique to the pediatric spine render this population susceptible to spinal cord injuries without radiographic abnormalities (SCIWORA). To date, published descriptions of SCIWORA have been limited to a single region of the spinal column. We describe a case of a 3-year-old boy in whom, after a motor vehicle accident, tandem SCIWORA lesions involving the lower cervical spinal cord and thoracolumbar junction resulted in severe quadraparesis. The child was initially treated with 24 h of methylprednisolone followed by 3 months of external orthoses of both the cervical and thoracic spine. We include in this article a brief review of the literature and treatment guidelines for SCIWORA and postulate the mechanism of these tandem spinal cord injuries.