Injury to the spinal cord without radiological abnormality (SCIWORA) in adults

Kothari, Pritesh; Freeman, Brian J. C.; Grevitt, Michael; Kerslake, Robert

doi:10.1302/0301-620x.82b7.10641

Cited by 77 publications

(44 citation statements)

References 11 publications

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“…19 In the adult, SCIWORET is encountered more frequently than SCIWORA syndrome, even though both conditions are rare. 9,10,12,19 In recent years, the radiological assessment protocol for acute cervical spine trauma was challenged: increasingly the three standard radiological views are combined with MRI or helical CT of the complete cervical spine instead of conventional CT. [5][6][7] Especially in patients with neurological dysfunction, MRI probably is the first radiological modality to be applied. 4,5 Multiplane MRI not only depicts eventual neurocompression and discoligamentous injury, it may also show haematomyelia, cord transection and cord oedema.…”

Section: Discussionmentioning

confidence: 99%

“…2,12 Since MRI reliably depicts the location of the cord lesion, its rostral and caudal ends and the eventual presence of intra-axial haematomas, MRI, together with the clinical presentation, play an important role in the prognosis of the respective cord lesion. 4,5,[7][8][9]11,[13][14][15] Patients with a high intense cord lesion in T2-and a low intense lesion in T1-weighted MRI fare worse than patients with a lesion in T2-weighted images alone. 14,15 For focal cord oedema involving only one spinal segment or less, motor recovery can be expected in 72% of cases, in contrast to 42% in patients with oedema over more than one segment.…”

Section: Discussionmentioning

confidence: 99%

“…7 Thus, patients with cord oedema have a better prognosis than patients with intraaxial haematoma and a better prognosis is alloted to cases of small oedema extension and to an involvment of the lower cervical spine. 5,7,9,11,15 Cord injuries in patients with bony disruptions or luxations have a worse prognosis than cord injuries in patients without lesions of structures adjacent to the cord. 10,15 In the latter, probably the traumatic force applied on the spine was smaller.…”

Section: Discussionmentioning

confidence: 99%

“…4 The latter diagnostic methods are increasingly used in the acute stage and especially in case of neurological dysfunction at first presentation or in case of negative results of initial plain films and conventional CT. [5][6][7] Moreover, plain films and CT, on which spinal cord injury without radiological abnormality (SCIWORA) diagnosis usually is based, may be insufficient and additionally miss soft-tissue lesions. 3,8,9 MRI depicts several types of intrinsic cord lesions as well as neurocompressive and discoligamentous injuries. 4,10,11 The latter may be indicative of an unstable cervical spine with the danger of ongoing cord damage.…”

Section: Introductionmentioning

confidence: 99%

“…With increasing resolution, MRI is a very useful tool in evaluating prognosis of several of these lesions. 4,5,[7][8][9]11,[13][14][15] It is the aim of this report to present the assessment and the surgical treatment of a 73-year-old man who presented initially with a complete cord syndrome after blunt cervical spine trauma and to focus the attention on MRI appearance of cord oedema as well as discoligamentous lesions with subsequent spinal instability.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic cervical instability associated with cord oedema and temporary quadriparesis

Wenger

Pj²,

Alarcón³

et al. 2003

Spinal Cord

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Study design: A case report of blunt cervical spine trauma associated with cord oedema at the C3/C4 level with temporary Frankel/American Spinal Injury Association Grade A quadriparesis and motion segment instability without evidence of associated bony lesions (spinal cord injury without radiological abnormality, SCIWORA lesion). Objectives: By means of a rare and illustrative case, the reader's attention is focused on eventual marked cervical motion segment instability in SCIWORA patients. Setting: A department of Neurology in Quito, Ecuador and a department of Neurosurgery in Bern, Switzerland. Method: A 73-year-old man sustained blunt cervical spine trauma. After resolution of paraparesis, dynamic studies of the cervical spine revealed translational instability of C3 over C4. The patient underwent segment fusion by intervertebral cage insertion and plate fixation. Results: The patient had recovered almost completely from tetraparesis under conservative treatment. The postoperative course was uneventful. Solid bony fusion of the C3/C4 motion segment was obtained. Conclusion: Despite normal cervical alignment, the lack of bony lesions and neurological recovery, magnetic resonance imaging and dynamic studies may reveal marked translational cervical motion segment instability requiring segment fusion in order to prevent ongoing damage of the spinal cord.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Traumatic cervical instability associated with cord oedema and temporary quadriparesis

Wenger

Pj²,

Alarcón³

et al. 2003

Spinal Cord

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Neurological and spinal manifestations of the Ehlers–Danlos syndromes

Henderson¹,

Austin²,

Benzel³

et al. 2017

American J of Med Genetics Pt C

176

174

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The Ehlers–Danlos syndromes (EDS) are a heterogeneous group of heritable connective tissue disorders characterized by joint hypermobility, skin extensibility, and tissue fragility. This communication briefly reports upon the neurological manifestations that arise including the weakness of the ligaments of the craniocervical junction and spine, early disc degeneration, and the weakness of the epineurium and perineurium surrounding peripheral nerves. Entrapment, deformation, and biophysical deformative stresses exerted upon the nervous system may alter gene expression, neuronal function and phenotypic expression. This report also discusses increased prevalence of migraine, idiopathic intracranial hypertension, Tarlov cysts, tethered cord syndrome, and dystonia, where associations with EDS have been anecdotally reported, but where epidemiological evidence is not yet available. Chiari Malformation Type I (CMI) has been reported to be a comorbid condition to EDS, and may be complicated by craniocervical instability or basilar invagination. Motor delay, headache, and quadriparesis have been attributed to ligamentous laxity and instability at the atlanto‐occipital and atlantoaxial joints, which may complicate all forms of EDS. Discopathy and early degenerative spondylotic disease manifest by spinal segmental instability and kyphosis, rendering EDS patients prone to mechanical pain, and myelopathy. Musculoskeletal pain starts early, is chronic and debilitating, and the neuromuscular disease of EDS manifests symptomatically with weakness, myalgia, easy fatigability, limited walking, reduction of vibration sense, and mild impairment of mobility and daily activities. Consensus criteria and clinical practice guidelines, based upon stronger epidemiological and pathophysiological evidence, are needed to refine diagnosis and treatment of the various neurological and spinal manifestations of EDS. © 2017 Wiley Periodicals, Inc.

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Sciwora

Isern-Kebschull¹

2016

Critical Findings in Neuroradiology

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Injury to the spinal cord without radiological abnormality (SCIWORA) in adults

Cited by 77 publications

References 11 publications

Traumatic cervical instability associated with cord oedema and temporary quadriparesis

Traumatic cervical instability associated with cord oedema and temporary quadriparesis

Neurological and spinal manifestations of the Ehlers–Danlos syndromes

Sciwora

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