Introduction. Falls and minor sports injury is a preceding event in 20% of children with transverse myelitis. This often resembles Spinal Cord Injury Without Radiological Abnormality (SCIWORA), a pre-MRI era label describing residual neurological deficits with normal spinal cord imaging following traumatic injury (bony/muscle injury is now evident with MRI), which often responds well to steroid treatment.

Methods. We analyzed clinical and neuroimaging data from children reporting falls and sporting injury prior to acute spinal cord symptomatology in a tertiary hospital from 2007-2016. Violent injuries (e.g. road traffic accidents) were excluded.

Results. Twenty-three children (10 boys, 13 girls) of median age 10.6 (range 2.7 – 15.5) years were included. Falls occurred at home or school (10 children), others reported injuries from rugby, cycling, swimming, gym activity, dance and heavy lifting. Recorded American Spinal Injury Association (ASIA) scores were A (30%) and D (70%). Final diagnosis was definite myelitis (spinal fluid or MRI inflammation) in 5 (22%) children, SCIWORA (8, 35%) and arteriovenous malformation (3, 13%). Six (26%) had a cord lesion without evidence of inflammation (overlap myelitis/SCIWORA). One child had a dissociative disorder. Ten (43%) received immunotherapy. Follow-up was available in 22 children (median 2.5 (0.5-10) years) with 13 (59%) having a normal outcome (modified Rankin Score, mRS 0). An acute ASIA A score was the only factor predictive of disability (mRS 1-2)(OR 6.88, 95% CI 1.08-41.1).

Conclusion. Injury appears to play a role in spinal cord inflammation. Clinical and neuroimaging features of myelitis and SCIWORA overlap and require further study.