Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) – Clinical and Radiological Aspects

Abstract

SummaryThe acronym SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) was first developed and introduced by Pang and Wilberger who used it to define “clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability”. SCIWORA is a clinical-radiological condition that mostly affects children. SCIWORA lesions are found mainly in the cervical spine but can also be seen, although much less frequently, in the thoracic or lumbar spine. Based on reports from different authors, SCIWORA is responsible for 6 to 19% and 9% to 14% of spinal injuries in children and adults, respectively. Underlying degenerative changes, including spondylosis or spinal canal stenosis, are typically present in adult patients. The level of spinal cord injury corresponds to the location of these changes. With recent advances in neuroimaging techniques, especially in magnetic resonance imaging, and with increasing availability of MRI as a diagnostic tool, the overall detection rate of SCIWORA has significantly improved.

Thoracic spinal cord injury without radiologic abnormality in a pediatric patient case report

“…Spinal cord injury without radiologic abnormality (SCIWORA) was defined by Pang and Wilberger as ‘objective symptoms of myelopathy as a result of trauma with no radiologic or computed tomographic (CT) evidence of spinal fracture or ligamentous instability’. This definition does not include obstetric complications, congenital spine anomalies and penetrating or electric current spinal injuries [ 1 ].…”

“…The prevalence of SCIWORA is 6–19% of all pediatric spinal cord injuries [ 1 ], having a first peak under the age of 8, and a second in elder patients with spondylosis [ 2 ].…”

“…This syndrome classically presents with clinical-radiologic dissociation, where the main symptom is upper extremity neurological deficit. The onset of clinical symptoms is usually delayed, occurring in the first 48 h post-trauma in 50% of the patients [ 1 ].…”

“…The most recommended treatment consists in external immobilization [ 1 ] of the spine and some authors suggest antihypertensive treatment [ 7 ].…”

Spinal Cord Injuries without Visible Bone Lesions: Analysis of Four Consecutive Cases

“…. That's probably what happened to the young woman who had a sport's accident in our series although CT angiography of supra aortic vessels rulled out arterial dissection.SCIWORA is less common in the thoracic than in the cervical region, because the thorax and abdomen protect the thoracic vertebrae from forced excessive flexion or extension[5] [6].The MR imaging in the evaluation of SCIWORA is the gold standard, it serves to exclude lesions that may require emergency decompressive surgery, such as extra axial hematomas and disc herniation, and it serves as a prognosis factor for neurological recovery[7] [8]. Neurological status on admission determines the long-term outcome.…”