Spinal cord injury without radiographic abnormality
Spinal cord injury without radiographic abnormality (SCIWORA) is a spinal cord injury (SCI) with no evidence of injury to the spinal column present on radiographs.[1] Spinal column injury is trauma that causes fracture of the bone or instability of the ligaments in the spine; this can coexist with or result in injury to the spinal cord itself but each injury can occur without the other.[2] Abnormalities might show up on magnetic resonance imaging (MRI), but the term was coined before MRI was in common use.[3]
SCIWORA may present as a complete spinal cord injury (total loss of sensation and function below the lesion) or incomplete spinal cord injury (some sensation and/or function is preserved). It is present in a significant number of children with SCI.[4] It was first described in children with a clinico-radiological mismatch by Pang and Wilberger.[5] Later, a similar condition was reported in adults. It is most common in children.[6] There seem to be relevant differences between pediatric and adult SCIWORA. In particular, adults often present with degenerative changes of the spinal column resulting in predisposing spinal stenosis.[7] SCI in adults could be due to instability of vertebral ligaments or a herniation of a disk or a hematoma around the spinal cord that presses on it—none of which would show up on X-rays.[4] In older people, spondylosis or problems with blood vessels can cause SCIWORA.[4] The most common cause is being hit by a vehicle while on foot.[6]
Diagnosis
The application of MRI plays a significant role in the early diagnosis and treatment of SCIWORA in children and adults. Recently, systematic reviews on SCIWORA described the clinical and radiological patterns and correlations with neurological outcome.[8][9] Boese and Lechler proposed a MRI-based classification for SCIWORA which correlated with the neurological outcome:[8]
| Type 1 | No detectable abnormalities. |
| Type 2 a | Extraneural abnormalities. |
| Type 2 b | Intraneural abnormalities. |
| Type 2 c | Extraneural and intraneural abnormalities. |
References
- ↑ Peitzman et al. 2012, p. 288.
- ↑ Peitzman et al. 2012, p. 288–9.
- ↑ Peitzman et al. 2012, p. 289.
- 1 2 3 Brown, Wyatt & Illingworth 2008.
- ↑ Pang und Wilberger: "Spinal cord injury without radiographic abnormalities in children." In: J Neurosurg. 57, 1982.
- 1 2 Bigelow & Medzon 2011, p. 180.
- ↑ Boese CK, Nerlich M, Klein SM, Wirries A, Ruchholtz S, Lechler P.: Early magnetic resonance imaging in spinal cord injury without radiological abnormality in adults: A retrospective study. In: Journal of Trauma and Acute Care Surgery. 74, 2013, S. 845–848, doi:10.1097/TA.0b013e31828272e9.
- 1 2 C.K. Boese und P. Lechler: Spinal cord injury without radiologic abnormalities in adults: a systematic review. In: Journal of Trauma and Acute Care Surgery. 78, 2015, S. 320-330 doi:10.1097/TA.0b013e31829243c9.
- ↑ Boese CK, Oppermann J, Siewe J, Eysel P, Scheyerer MJ, Lechler P.: Spinal cord injury without radiologic abnormality in children: a systematic review and meta-analysis. In: Journal of Trauma and Acute Care Surgery. 75, 2013doi:10.1097/TA.0000000000000579.
Bibliography
- Bigelow, S.; Medzon, R. (16 June 2011). "Injuries of the spine: Nerve". In Legome, E.; Shockley, L.W. Trauma: A Comprehensive Emergency Medicine Approach. Cambridge University Press. ISBN 978-1-139-50072-2.
- Brown, J.; Wyatt, J. P.; Illingworth, R. N.; Clancy, M. J.; Munro, P. (6 June 2008). Oxford American Handbook of Emergency Medicine. Oxford University Press. ISBN 978-0-19-977948-2.
- Peitzman, A.B.; Rhodes, M.; Schwab, C. W.; Yealy, Donald M.; Fabian, Timothy C. (2012). The Trauma Manual: Trauma and Acute Care Surgery. Lippincott Williams & Wilkins. ISBN 978-1-4511-1679-3.