Spinal cord injury without radiographic abnormality (SCIWORA) is symptoms of a spinal cord injury (SCI) with no evidence of injury to the spinal column on. The misapplication of the term spinal cord injury without radiographic abnormality (SCIWORA) in adults. J Trauma Acute Care Surg ; – 1 Mar Pang and Wilberger1 defined the term spinal cord injury without radiographic abnormality (SCIWORA) in as “objective signs of.
|Published (Last):||10 November 2013|
|PDF File Size:||14.63 Mb|
|ePub File Size:||19.77 Mb|
|Price:||Free* [*Free Regsitration Required]|
In a retrospective case series from Martinez-Perez et al.
In a postmortem study with 30 cases whose autopsy findings indicated gross or microscopic injuries to the spinal column or cord, Makino et al. Magnetic resonance imaging correlation in pediatric spinal cord injury without radiographic abnormality. There were no bony abnormalities on x-rays or CT scans. Venous congestion within the compressed spinal cord is an additional pathogenic factor. 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.
When performing physical examination it is important to bear in mind that neurological deficits may only become apparent after several days of injury. The prevalence of this condition is highest among children below 8 years of age who sviwora have the most unfavorable prognosis, which is probably associated with relatively heavy sciowra, weaker neck muscles and greater elasticity of vertebral ligaments in this patient population [ 4 — 6 ].
Pang and Wilberger 1 and Pang 7 found the presenting neurological examination to relate strongly to outcome. The regions of complete injury tend to be cervical and upper thoracic. Even mild hyperextension injury can cause a central cord syndrome in patients with spinal stenosis. The presence of frank hematomyelia or cord disruption is associated with a severe, permanent neurological injury. Trauma and Acute Care Surgery. Most of the patients in these reports are adolescents and young adults injured during athletic activities, especially American tackle football.
Trauma of the spine and spinal cord: This could be undertaken in a longitudinal study of a patient population of reasonable size. Pure intraneural MRI findings including edema or hemorrhage within the cord parenchyma is not an indication for surgery. It is unclear, however, what role immobilization plays in this population once dynamic radiographs have confirmed the absence of instability.
In asymptomatic patients who obtained stable spine fixation as assessed by flexion and extension dynamic radiographs, external immobilization devices can be removed earlier. Specific assessments to determine spine injury should include clinical examination, with a special focus on neurological examination.
No child with SCIWORA has been documented in the literature to have had normal dynamic radiographs and then subsequently develop intersegmental instability. In addition, dynamic flexion and extension radiographs or fluoroscopy has been advocated to exclude pathological intersegmental motion consistent with ligamentous injury without fracture.
Spinal cord injury in the pediatric population: However, hemorrhages will again appear hypointense on T2WI sciworq to the presence of hemosiderin-laden macrophages in the chronic phase.
MR imaging at 1. No child with SCIWORA has developed pathological intersegmental motion with instability when early flexion and extension radiographs have been normal.
However, the main reason for the priority of conservative treatment in the management of SCIWORA patients is not the mild nature of the injury, but the absence of bony involvement and malalignment. The adult spinal cord injury without radiographic abnormalities syndrome: The lack sciwota intramedullary findings correlated with a normal neurological outcome.
Spinal cord injury without radiographic abnormality in children–the SCIWORA syndrome.
Finally, the use of magnetic resonance imaging MRI allowed for even better depiction of the spine and soft tissue abnormalities in particular. Acute cervical spine trauma: Acute or chronic myelitis should also be excluded [ 1617 ]. Because of these observations, one should consider radiographs of the entire spinal column when any traumatic spinal injury is identified in a child, SCIWORA or otherwise.
Although clinical signs and symptoms can be observed from the moment of injury, neurological deficits may only become apparent several days after the injury due to second-hit phenomenon, edema, or a developing hematoma around the cord [ 21 ].
Spinal Cord Injury without Radiographic Abnormality (SCIWORA) – Clinical and Radiological Aspects
SCIWORA is a widely recognized form of spinal cord injury, occurring almost exclusively in children, and is characterized by the absence of any radiographically evident fracture, dislocation, or malalignment. Spinal injuries in the pediatric age group: Chronic hematoma would give a similar appearance, except for the presence of spinal edema. If normal physiological motion of the spinal column can potentiate spinal cord injury SCIWORA in these patients when there is no malalignment, subluxation, or lesion causing cord compression, then immobilization may be warranted in these patients.
Diagnostic Evaluation After the initial management in the field, diagnostic evaluation of patients with presumed SCI should start with a detailed history which can be possibly taken from eyewitnesses to determine the mechanism of injury [ 5 ].
A hyperintense area pointed by an arrow represents edema of the spinal cord.
SCIWORA | Radiology Reference Article |
Since overt signs of spinal trauma, such as fractures and dislocations, are absent in SCIWORA, nonsurgical strategies, including immobilization and corticosteroid therapy, are the mainstay of treatment. There are characteristic pathomorphological soft tissue changes in SCIWORA patients that could only be detected using MRI but not in plain films or CT images including spinal cord hematomas, transections, discoligamentous injuries, spinal cord edema, and compression [ 28 — 31 ]. Current Opinion in Pediatrics.
Five of the 7 studies revealed no abnormality, and 2 studies documented intramedullary sciwors changes. Abstract Spinal cord injury in children frequently occurs without fracture or dislocation.
Spinal cord injury without radiographic abnormality – Wikipedia
They also advocated external immobilization for this time frame to prevent recurrent injury during the healing phase. SSEPs are signals generated by the nervous system in response to electrical stimulation of a peripheral nerve.
The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.