Spinal cord injuries without radiographic abnormalities ( SCIWORA ) are symptoms of spinal cord injury (SCI) with no evidence of spinal injury in X-rays or CT scans. Symptoms may include numbness, weakness, abnormal reflexes, or loss of bladder or bowel control. Neck or back pain is also common. Symptoms may be brief or persistent. Some do not experience symptoms until a few days after the injury.
The causes may include motor vehicle crashes, falls, sports injuries, and unintentional trauma. A number of proposed underlying mechanisms include bruising of the spinal cord, injury to the blood supply to the spinal cord, and excessive stretching of the umbilical cord. Magnetic resonance imaging (MRI) is recommended to determine if there are further problems.
Treatment is often based on MRI findings and whether or not persistent symptoms. If MRI is normal and symptoms are not resolved or a short neck brace may be recommended. Otherwise, a rigid cervical neck or surgery to paralyze the neck for three months is recommended. If MRI is an abnormal operation to hold the throat still can be done Usually one should avoid further high risk activity for the next six months. The use of corticosteroids is generally not recommended.
Conditions are rare. Most cases are believed to occur in children and the elderly. Men are more affected than women. The results are generally good if the MRI is normal but less so if the problem is found. The low mortality risk is about 2%. It was first defined in 1982.
Video Spinal cord injury without radiographic abnormality
Signs and symptoms
SCIWORA may present as complete spinal cord injury (total loss of sensation and function under the lesion) or incomplete spinal cord injury (some sensation and/or function is maintained). It is present in a large number of children with SCI. In particular, clinical symptoms may present with delayed hours until the day after trauma. This phenomenon is especially noticeable in children but is reported in adults as well. The duration of symptoms varies greatly. Full recovery can be achieved without treatment within minutes to hours and permanent injury may occur. Overall, there appears to be an association between the extent of damage to the spinal cord and clinical prognosis. The prognostic value of intra- and extra-medullary MRI findings of ongoing research subjects in the field of SCIWORA.
Maps Spinal cord injury without radiographic abnormality
Diagnosis
The application of MRI plays an important role in early diagnosis and treatment of SCIWORA in children and adults. More recently, a systematic review of SCIWORA illustrates clinical and radiological patterns and correlations with neurologic outcomes. Boese and Lechler proposed an MRI-based classification for SCIWORA that correlated with neurologic outcomes:
History
The SCIWORA acronym was invented by Pang and Wilderer in 1982. The first description of spinal cord injury with radiological-clinical discrepancy was followed by a large number of case reports and case series. Later, similar conditions were reported in adults. This is most common in children. There seems to be a relevant difference between pediatric and adult SCIWORA. In particular, adults often present with degenerative changes of the spine that cause predisposition of spinal stenosis. SCI in adults may be due to vertebral ligament instability or disc herniation or hematoma around the spinal cord that compresses it - nothing will appear on X-rays. In older people, spondylosis or problems with blood vessels can cause SCIWORA. The most common cause is getting hit by a vehicle on foot.
Prior to 1982, the phenomenon of radiological-clinical discrepancy was also known. Historical literature on spinal cord concussion, spinal cord contusion and hiperextensive/spinal hyperflexions represent a similar case in the modern case of SCIWORA.
After the introduction of SCIWORA, the term was extended to adults with degenerative changes. Some authors use the term spinal cord injury without evidence of traumatic radiography (SCIWORET) to describe these cases. In addition, the introduction of computed tomography allows a more detailed description of the spine. Thus, the identification of previously missed injuries calls for limitations of SCIWORA and SCIWORET classics. The term SCIWOCTET (spinal cord injury without evidence of CT trauma) was introduced. Finally, the use of magnetic resonance imaging (MRI) allows for better depiction of spinal and soft tissue disorders in particular. Again, a new acronym is proposed to classify patients without traumatic signs using radiography, CT and MRI. The term spinal cord injury without neuroimaging abnormality (SCIWONA) is used. However, the new acronym is not generally accepted and the more common term SCIWORA is commonly used to describe all variants of radiological-radiological mismatch.
References
External links
Bibliography
- Bigelow, S.; Medzon, R. (June 16, 2011). "Spinal Injuries: Nerves". In Legome, E.; Shockley, L.W. Trauma: A Comprehensive Emergency Treatment Approach . Cambridge University Press. ISBN: 978-1-139-50072-2. CS1 maint: Using parameter editor (link)
- Brown, J.; Wyatt, J. P.; Illingworth, R. N.; Clancy, M. J.; Munro, P. (June 6, 2008). Oxford American Handbook of Emergency Medicine . Oxford University Press. ISBN 978-0-19-977948-2.
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