Spinal Cord Injury Without Radiographic Abnormality (SCIWORA)

Marinier, Margaret; Rodts, Mary Faut; Connolly, Maria A.

doi:10.1097/00006416-199709000-00015

Cited by 13 publications

(9 citation statements)

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“…Thoracic and lumbar spine injuries are also more common in this age group. For these reasons, the most severe cases of SCIWORA have previously been reported in children less than 8 years of age [4,9,15,17,18,32]. In our series of patients with traumatic myelopathy there was no observed predilection for the level of injury based on age.…”

Section: Discussionmentioning

confidence: 45%

“…There are specific anatomical features that cause the pediatric population to be vulnerable to such forces, such as anterior wedging of the vertebral bodies, horizontally oriented facets, overly elastic ligaments, absence of uncovertebral joints, immature nuchal musculature and a high head-to-trunk ratio [4,5,6,9,11,13,14,15,16,17,18,19]. All of these distinct features are responsible for the malleability and vulnerability of the pediatric spine.…”

Section: Discussionmentioning

confidence: 99%

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Spinal Cord Injuries without Radiographic Abnormality at Two Pediatric Trauma Centers in Ontario

Trigylidas¹,

Yuh²,

Vassilyadi³

et al. 2010

Pediatr Neurosurg

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Background: Spinal cord injury without radiographic abnormality (SCIWORA) represents a traumatic myelopathy, either transient or permanent, that is not associated with visible vertebral fractures or ligamentous abnormalities on plain radiographs or CT. MRI has become essential in the diagnosis and evaluation of trauma patients and in predicting the long-term neurological outcome. Methods: The medical charts of 578 children with vertebral trauma at the Children’s Hospital of Eastern Ontario and the Hospital for Sick Children were retrospectively reviewed. Results: Forty-five patients were identified as having traumatic myelopathy. Three of these patients had SCIWORA. Two sustained thoracic spinal cord injuries as a result of motor vehicle accidents and permanent neurological deficits. The third was involved in a sports-related injury and sustained a cervical spine injury that improved in 48 h. Conclusions: SCIWORA is uncommon. The serious neurological sequelae that can result from a missed diagnosis merit more attention in identifying a spinal lesion in children with traumatic myelopathy. MRI has played a valuable role in this respect and may be even more predictive of outcome than the presenting neurological findings. The SCIWORA acronym can be modified to SCIWONA (spinal cord injury without neuroimaging abnormality) in order to highlight the importance of MRI in the prognosis.

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Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Spinal Cord Injuries without Radiographic Abnormality at Two Pediatric Trauma Centers in Ontario

Trigylidas¹,

Yuh²,

Vassilyadi³

et al. 2010

Pediatr Neurosurg

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“…Desde o início do uso do acrônimo SCIWORA, em 1982, vários estudos têm sido publicados sobre esta síndrome [4][5][6][7][8][9][10][11][12][13][14][15][16][17] . Em aproximadamente 35% dos pacientes pediátricos vítimas de traumatismos com lesão medular não se evidenciam alterações ósseas ou ligamentares 4 .…”

Section: Discussionunclassified

“…Apesar da imobilização por cerca de 12 semanas, aproximadamente 44% dos pacientes não demonstram melhora com o tratamento 6 . A recorrência da SCIWORA é secundária à mobilização da medula espinhal dentro de curto período de tempo após tratamento inadequado ou ausente e freqüentemente resulta em déficits neurológicos mais severos que os da síndrome inicial 9,13 .…”

Section: Fig 2 Ressonância Magnética De Medula Espinhal Em Cortes Saunclassified

Avulsão medular torácica sem anormalidades radiológicas: relato de caso

Falavigna

Mattana²,

Teles

et al. 2006

Arq. Neuro-Psiquiatr.

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RESUMO -Lesão medular sem anormalidade radiológica é condição rara que acomete mais comumente crianças e contribui com altas taxas de morbidade nestes pacientes. Relatamos um caso de um lactente de cinco meses vítima de acidente automobilístico que se apresentava com nível sensitivo em T2 e paraplegia crural bilateral. Exames radiográficos e tomografia computadorizada de coluna vertebral não evidenciaram lesões ósseas ou ligamentares. A ressonância magnética mostrou transecção completa associada com avulsão medular em segmento compreendido entre T3 a T7. Discutimos esta patologia segundo sua epidemiologia, fisiopatologia, diagnóstico, tratamento e prognóstico. PALAVRAS-CHAVE: medula espinhal, traumatismo da medula espinhal, mielopatia traumática, lesões, avulsão. Thoracic spinal cord avulsion without radiologic abnormalities: case reportABSTRACT -Spinal cord injury without radiologic abnormalities is a rare condition that occurs more frequently in children and contributes to a high rate of morbidity among these patients. We report the case of a fivemonth-old infant, victim of automobile accident, who was brought to our service with a sensitive level in T2 and bilateral crural paraplegia. Radiographic exams and computed tomography of spine did not evidence of bone or ligaments injuries. Magnetic resonance image showed complete spinal cord transection and spine avulsion in the segment between T3 and T7. We discuss this pathology according to its epidemiology, pathophysiology, diagnosis, treatment and prognostic aspects.KEY WORDS: spinal cord, spinal cord injury, traumatic myelopathy, injury, avulsion.O conceito de lesão medular sem anormalidade radiológica foi descrito em 1907 por Lloyd 1 , e seu acrônimo SCIWORA (spinal cord injury without radiographic abnormality) foi proposto por Pang e Wilberger em 1982 2 . Os autores estudaram crianças vítimas de traumatismos que apresentavam mielopatia com resultados normais de radiografia, tomografia computadorizada (TC) e mielografia da coluna vertebral 2 . Acredita-se que ocorram cerca de 1000 novos casos de lesão medular em crianças por ano no Canadá 3 , sendo 1% a 10% de etiologia traumática 4,5 . A incidência de SCIWORA em pacientes pediátricos com mielopatia decorrente de traumatismos varia de 5% a 67%, a média dentre a maioria das séries relatadas sendo 34,8% 4 . Os pacientes pediátricos são responsá-veis por 90% dos casos de SCIWORA 6 .Relatamos um caso SCIWORA em uma criança. CASOPaciente de cinco meses, do sexo masculino, estava sentado ao colo da mãe, no banco da frente do automóvel e sem cinto de segurança, quando ocorreu colisão frontal contra outro veículo sem capotagem. No momento do resgate pela unidade móvel, o que ocorreu aproximadamente 80 minutos após o acidente, a criança encontrava-se chorando, caída no banco da frente do automóvel.Por ocasião da chegada ao hospital apresentava-se em regular estado geral, hipocorado, acianótico, anictérico e hipoativo ao manuseio. O exame apresentava nível sensitivo em T2 com paraplegia crural bilateral. A ultra-sonogr...

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“…The spinal lesions are caused by longitudinal distraction and ischaemia [4]. In children younger than 3 years, the most frequent aetiologies are motor vehicle accidents [5]. Associated lesions are frequent and can include femoral fractures [6].…”

Section: Introductionmentioning

confidence: 99%

Delayed Diagnosis of Neurological Bladder following Spinal Cord Injury without Radiological Abnormality

et al. 2013

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Spinal cord injuries are a well-known cause of neurological bladder and a well-known complication of high-velocity trauma. They can, however, be difficult to diagnose in young children, in whom the absence of initial neurological symptoms and normality of the radiological workup can be falsely reassuring. Management of associated injuries can further delay diagnosis. We present 2 cases of spinal cord injuries without radiological abnormality revealed by delayed bladder retention.

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Spinal Cord Injury Without Radiographic Abnormality (SCIWORA)

Cited by 13 publications

References 0 publications

Spinal Cord Injuries without Radiographic Abnormality at Two Pediatric Trauma Centers in Ontario

Spinal Cord Injuries without Radiographic Abnormality at Two Pediatric Trauma Centers in Ontario

Avulsão medular torácica sem anormalidades radiológicas: relato de caso

Delayed Diagnosis of Neurological Bladder following Spinal Cord Injury without Radiological Abnormality

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