Will the Real SCIWORA Please Stand Up? Exploring Clinicoradiologic Mismatch in Closed Spinal Cord Injuries

Dreizin, David; Kim, Wendy; Kim, Jane S.; Boscak, Alexis R.; Bodanapally, Uttam K.; Múnera, Felipe; Stein, Deborah M.

doi:10.2214/ajr.14.13374

Cited by 30 publications

(22 citation statements)

References 66 publications

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“…Small extraspinal haemorrhages and isolated cord oedema are associated with a better prognosis and patients usually demonstrate full or nearly full recovery. 12 This prognostic value of early MRI was confirmed in our study. T2-weighted images have the best prognostic value for closed spinal cord injuries and are excellent at demonstrating disc, capsular and muscle injuries.…”

Section: Mri Findingssupporting

confidence: 82%

“…There has been much debate about the relevance of the term SCIWORA in an age where MRI is readily available and often performed as initial investigation in patients with spinal injuries. Several alternatives have been suggested, such as SCIWORET (SCI without radiographic evidence of trauma), SCIWOCTET (SCI without CT-evidence of trauma) 12 or SCIWONA (SCI without neuroimaging abnormality), 13 which may be a more accurate and relevant description of this particular injury.…”

Section: Mri Findingsmentioning

confidence: 99%

“…T2-weighted images have the best prognostic value for closed spinal cord injuries and are excellent at demonstrating disc, capsular and muscle injuries. 12 Although the short tau inversion recovery (STIR) method is preferred to detect subtle cord oedema in spine injured patients, 14 not all of our patients had this sequence performed and we therefore did not report on it.…”

Section: Mri Findingsmentioning

confidence: 99%

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Ligamentous integrity in Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case series

et al. 2017

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Purpose of study: Prolonged bracing following injury in patients with Spinal Cord Injury without Radiographic Abnormality (SCIWORA) remains controversial. Some authors claim that there is occult instability and a risk of recurrent injury whereas others propose that the spinal column will deform elastically, but will return to its baseline stability by elastic recoil. We aim to assess the presence of ligamentous injury on MRI and the incidence of recurrent instability following SCIWORA in order to determine the need for prolonged bracing.Methods: A retrospective chart review was performed for a series of 12 patients with documented SCIWORA that presented to Red Cross Children's Hospital over the past 8 years. Details regarding mode of injury, age at presentation, neurological deficit at presentation, MRI findings and long-term prognosis were documented.Results: There were nine males and three females. The median age was 4.35 years. All patients were victims of high energy motor vehicle accidents. In two patients there was disruption of the ligamentum flavum at the level of the injury. There were no episodes of recurrent instability or neurological compromise in those patients that had recovered. None of our patients had rigid bracing following the diagnosis of SCIWORA. Conclusion:Infrequently observed disruption of isolated stabilising structures in SCIWORA did not lead to early or delayed instability in our patients. We did not find evidence to support the practice of prolonged rigid bracing to prevent recurrence following SCIWORA. Level of evidence: Prognostic case study, level IVKey words: SCIWORA, paediatric spinal cord injury, MRI findings in SCIWORA, bracing in SCIWORA, paediatric trauma http://dx

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Section: Mri Findingssupporting

confidence: 82%

Section: Mri Findingsmentioning

confidence: 99%

Section: Mri Findingsmentioning

confidence: 99%

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Ligamentous integrity in Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case series

et al. 2017

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“…As a point of final clarification, there are a myriad of terms which have emerged around SCIWORA, including SCIWORET (SCI without radiographic evidence of trauma), SCIWOCTET (SCI without CT evidence of trauma) and SCIWONA which are variably applied to pediatric and adult patients [2,27,28]. These terms appear misguided when applied to the explanation for a SCI.…”

Section: Older Adults With Hyper-extension Injury (And Underlying Stementioning

confidence: 99%

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

Rolfe

Beck

Kovach

et al. 2019

Spinal Cord Ser Cases

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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.

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“…Blunt injuries of the spinal cord without overt skeletal or ligamentous disruption account for a significant proportion of spinal cord injuries (SCIs) in children, and most commonly occur in children younger than 8 years of age. 1,2 In some cases, SCIs occur without radiographic abnormalities; this condition is referred to as SCIWORA. The term 'real SCIWORA' is also used when the findings of all imaging modalities-including MRI-are negative.…”

Section: Introductionmentioning

confidence: 99%

A case of real spinal cord injury without radiologic abnormality in a pediatric patient with spinal cord concussion

Nagasawa

Ishikawa

Takahashi

et al. 2017

Spinal Cord Ser Cases

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The present case study, in which MRI was performed, showed that an immediate improvement was obtained in a patient who experienced real SCIWORA. The importance of not only spinal cord lesions, but also perispinal soft tissue injury on MRI has been emphasized for predicting patient outcomes. Accordingly, immediate MRI is essential for evaluating patients with signs and symptoms of spinal cord injury, even when plain neck roentgenography and cervical CT are negative.

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Will the Real SCIWORA Please Stand Up? Exploring Clinicoradiologic Mismatch in Closed Spinal Cord Injuries

Abstract: Knowledge of the lexicon of spinal cord injury without radiographic abnormality, the spectrum of MRI findings, and imaging predictors of outcome can help render a precise imaging diagnosis and can provide evidence-based prognostic information.

Cited by 30 publications

References 66 publications

Ligamentous integrity in Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case series

Ligamentous integrity in Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case series

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

A case of real spinal cord injury without radiologic abnormality in a pediatric patient with spinal cord concussion

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