Cervical spinal cord injuries without radiographic evidence of trauma: a prospective study

Abstract

Study design: Prospective study. Objectives: In a prospective study, 45 consecutive cases of cervical spinal cord injury without radiographic evidence of trauma (SCIWORET) who were treated non-operatively were analyzed to correlate the magnetic resonance image findings with the initial neurological deficit and the extent of neurological recovery at 2 years. Setting: University tertiary-care teaching hospital in South India. Methods: The neurological status of patients who did not have any radiographic or computerized tomographic abnormality at the time of admission was assessed by ASIA Impairment Scale (AIS) modification of Frankel's grading. The spinal cord abnormality seen in the magnetic resonance imaging was noted. The neurological status at the end of 2 years was recorded. Results: Twenty-seven of the 45 patients (60%) had cord oedema, 8 (17.77%) had cord contusion, 8 (17.77%) patients had a normal cord and 2 (4.44%) patients had cord swelling on the magnetic resonance image. Out of 27 patients who presented with cord oedema, 14 (31.11%) patients recovered from AIS D to AIS E and 6 (13.33%) patients did not recover and remained at AIS D. Seven (15.55%) patients who had a normal cord recovered completely to AIS E. Five (11.11%) patients who had contusion of the cord recovered up to AIS D. Conclusion: The initial neurological status correlates with magnetic resonance imaging findings. Subsequent neurological recovery is dependent on the type of cord damage and initial neurological status. The rate of recovery and the final motor outcome are inversely related to the length of cord involvement.

Posttraumatic Spinal Cord Injury without Radiographic Abnormality

“…Extraneural findings were disc herniation, ligamentum flavum bulging, prevertebral soft tissue swelling, or ligamentous abnormalities [ 33 ]. There is evidence in the literature suggesting that SCIWORA patients with no detectable MRI abnormalities usually have a better prognosis and recovery rate than the patients with MRI abnormalities [ 34 , 35 ].…”

“…At three-month follow-up, a decision as to whether the patient should have another MRI is made on an individual basis. Although the latter is the most widely accepted immobilization protocol, some authors suggest using halter traction with a minimal weight for the first three weeks and immobilization in an extended cervical collar until three months after the injury [ 35 ]. Interestingly, Bosch et al [ 40 ] reported 21 patients with recurrent SCIWORA; 14 of them sustained their repeat episode while still wearing a rigid type of cervical brace.…”

“…It is imperative to note that evidence to date does not include any randomized controlled trials to prove the superiority of one practice or suggestion over another. However, immobilization of the spine until the spine tenderness clears, the neurologic examination has normalized, and MRI is negative for instability is the universally accepted initial nonsurgical treatment approach [ 5 , 10 , 21 , 35 , 36 , 40 ]. Regardless of the immobilization type, all SCIWORA patients are advised to refrain from any physical activities that may increase the risk of reinjury for approximately six months [ 21 ].…”

Spinal cord injury without radiographic abnormality (SCIWORA) in adults: MRI type predicts early neurologic outcome

“…Although a correlation between neurological outcome and MRI pattern has been described previously, 4,5,[11][12][13][14][15][16][17][18] this finding could not be confirmed by others. 2 The present study reports the existence of a relation between imaging type and neurological outcome in adult patients with SCIWORA.…”

A geriatric patient with spinal cord injury without radiographic abnormality: outcomes and causes

“…Causes such as comorbid diseases affect the outcome. Pathogenesis, incidence, and outcome vary among different age groups because of anatomical and biomechanical differences [1,[3][4][5][6][7]. Previous studies have limited data concerning the clinical prognosis of SCIWORA because of the rarity of the disease in adults, especially in geriatric patients.…”