Non-locality and the misdiagnosis of Spinal Cord Injury Without Radiographic Abnormality: proof of concept

Abstract

Study Design This is a retrospective review. Objectives To validate the concept of "non-locality" to explain cases of Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) previously deemed inexplicable. To investigate and challenge the source data for the SCIWORA hypothesis which has the built-in assumption that a traumatic spinal cord injury (SCI) can only be caused by a local or adjacent spinal column injury and which, therefore, postulates that the pediatric spinal column is inherently more flexible than the spinal cord to explain SCI whenever a local spinal column injury is not detected. Setting A National Rehabilitation Center, one of fourteen which reports to the Spinal Cord Injury Model System. Methods We examined all residual SCIWORA cases over a 5-year period. In addition, we performed an extensive literature search to trace the evidence supporting the SCIWORA hypothesis that children's spinal columns are inherently lax and may stretch more than the spinal cord prior to disruption. Results Six SCI patients with a residual diagnosis of SCIWORA were identified, 3 pediatric and 3 adult. All had injuries fitting non-locality. None were an actual SCIWORA. Source data do not appear to support the SCIWORA hypothesis. Conclusion Borrowing from quantum mechanics, we reveal non-locality as a real entity in the spine. The assumption of locality-only is invalid and likely contributed to the SCIWORA hypothesis for the pediatric spine. Misdiagnosis and misunderstanding of SCIWORA may lead to improper treatment and increased cost. Awareness may facilitate search for adequate explanations for difficult cases rather than mere assignment as SCIWORA.

Analysis of the Curative Effect and Prognostic Factors of Anterior Cervical Surgery for Spinal Cord Injury without Radiographic Abnormalities

“…When the cervical vertebra suffers from hyperextension force, the cervical spinal cord is squeezed by the intervertebral discs protruding from the front and the folds of the ligamentum flavum in the rear, resulting in the injury with the central tube of the cervical spinal cord as the center, and then, the hemorrhage and edema around the central tube are the main pathological changes; central necrosis of the spinal cord may occur in severe cases [ 12 , 13 ]. The pathogenesis of SCIWORA is based on the existence of pathological factors in the spinal canal that reduces the reserve space, such as cervical disc herniation.…”

Pediatric SCIWORA-Type Injuries Revisited: What Should be the Most Discerning Definition of SCIWORA at the Current Days?

“…At the dawn of the 21 st century, the term SCIWORA had caught on [13], although the idea remains that the higher the resolution of imaging for spinal damage, especially MRI, the lower the number of true cases of SCIWORA [14]. Furthermore, the less spinal cord damage the initial MRI shows, the less severe the clinical manifestations of SCI and the better the prognosis [15].…”

“…It is our understanding, as it was for Pang and co-workers [12], that it is of great importance taking these subtle cases into account and carefully follow their evolution up, if only for two reasons: first, the potential impact on somatic growth and thus the development of subsequent orthopaedic deformities. The vast majority of SCIWORA cases affect patients under 6 years of age and are located in the cervical spine [12][13][14][15]17], i.e. patients in the process of growth and development.…”