Diagnosis and Prognosis of Adult Post-traumatic Cervical Cord Injury Without Radiographic Evidence of Trauma Using Magnetic Resonance Imaging

Abstract

Study DDesign: This is a retrospective review of 10 consecutive patients with spinal cord injury without radiographic evidence of abnormalities (SCIWORA) and 17 spinal cord injury patients without radiographic evidence of trauma (SCIWORET). Objectives: We wanted to assess the MRI and clinical findings, the prognosis and effect of anterior decompression of the spinal cord in SCIWORET patients. Summary o of t the L Literature R Review: SCIWORET is not uncommon among middle-age and elderly people. It is less reported in adults as compared with children. There are no studies on the method for the treatment or the effectiveness of anterior decompression of the spinal cord. Materials a and M Methods: From February 1994 to December 2005, this study included 27 patients who had cervical spinal cord injury without radiographic evidence of trauma on the plain roentgenography and MRI. Ten patients had no spinal cord compression (SCIWORA patients, group 1) and 17 had their spinal cord compressed from the anterior (SCIWORET patients, group2), We conservatively treated the group 1 patients and 10 of the group 2 patients, and anterior decompression and fusion were done for 7 of the group 2 patients. Neurological evaluation was performed initial and at last follow up using an ASIA motor score and the Frankel grade. Results: The patients who had spinal cord edema on MRI had a better prognosis than those who had contusion (p=0.06). There is no statistical difference between the two groups for the neurologic changes at the initial period and the last follow up period (p=0.06, 0.61). Decompression of the spinal cord anteriorly was not effective for the neurologic recovery (p=0.25) and the involved segments were not related to the neurologic changes (p=0.34, 0.25). Conclusions: It was presumed that patients with edema of the spinal cord had a better prognosis than those with contusion of the spinal cord. There was no difference between the SCIWORA and SCIWORET groups for the neurologic changes and anterior decompression was not effective for the recovery of neurologic symptoms. This study was limited by its retrospective nature and the small number of patients, so a multi-center study is needed.