Posttraumatic Spinal Cord Injury without Radiographic Abnormality

Abstract

“Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.

Spinal cord injury without radiologic abnormalities in a 4-years old boy

“…SCIWORA accounts for 1-10% of the spinal cord injury in children. Gregory et al [5] reported 0.08%cases in a multicentric study on about 34069 patients., SCIWORA is more common in children than adult with literature reports of 13 to 19% and 10 to 12% of children and adult spinal cord injuries respectively [6,8,9] The trauma causing SCIWORAs may not be of high intensity only, it may be trivial also. This is widely illustrated in the literature.…”

Nursing Care of a Patient with Cervical Spinal Cord Injury Without Fracture and Dislocation: A Case Report

“…Studies have reported that CSCIWFD is related to cervical spine degeneration and other factors, leading to a reduction in the effective cervical canal volume. However, the specific pathogenesis and treatment of this disease remain topics of debate [17,18]. Most researchers support surgical treatment and believe that surgery can reduce spinal cord edema, spinal canal decompression, improve spinal cord blood circulation, restore cervical spine stability, avoid and reduce secondary spinal cord injury, and facilitate spinal cord function recovery [19].…”

Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations

“…These include spinal cord traction and injury due to hyperflexion or hyperextension and parenchymal damage from edema or vascular injury. 57,63,64 It is conceivable that SCIWORA is seen less frequently in adults as a result of age-related changes in bone morphology and a decrease in ligamentous laxity. Preexisting degenerative changes to the spine, such as posterior vertebral spurs, ligamentum flavum bulging, and decreased vertebral body height are frequently found in adults presenting with a clinicoradiological mismatch.…”

“…Published reports indicate that patients with SCIWORA may present with a wide range of symptoms, including different level of lower and upper extremity weakness, sensory loss, paresthesia, changes in tendon reflexes, loss of bladder and bowel function, signs of anterior/central/posterior cord or Brown-Sequard syndrome. 57,67 Boese and Lechler 55 showed that adults most commonly presented with American Spinal Injury Association (ASIA) grade C (39.7%) and grade D (22.8%). 13 Patients with suspected SCI should first be checked with direct radiograms and CT scans.…”

“…56 Some authors state that SCIWORA might be underreported in adults, although this might be explained by the growing availability of CT/MRI scans. 39,55,[57][58][59] The term "adult SCIWORA", although rarely seen in literature, creates considerable controversy. In view of a profound discrepancy with the emergence of routine MRI protocols for patients with clinical signs of myelopathy, a series of more precise terms like "SCIWORET" (SCI without radiographic evidence of trauma), "SCIWOCTET" (SCI without CT evidence of trauma), "SCIWONA" (SCI without neuroimaging abnormality) and a few others have subsequently come into use (Table 3).…”