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Adult Spinal Cord Injury without Radiographic Abnormalities (SCIWORA): Clinical and Radiological Correlations.

Sharma S, Singh M, Wani IH, Sharma S, Sharma N, Singh D - J Clin Med Res (2009)

Bottom Line: Parenchymal spinal cord injury is the single most important determinant in the long term outcome of adult SCIWORA patients.Longitudinal signal extension and associated extra neural injuries are also associated with poorer outcomes.Cases with purely neural injuries can be managed conservatively, but associated extra neural injuries, especially disc prolapse and ligamentous instability, warrant surgical management.

View Article: PubMed Central - PubMed

Affiliation: Postgraduate Department of Orthopedics, Government Medical College, Jammu, India.

ABSTRACT

Background: This study is aimed to determine the clinical and radiological corellations of adult patients with Spinal Cord Injury Without Radiographic Abnormalities (SCIWORA).

Methods: The study population consisted of all adult patients with suspected cervical spine injury. SCIWORA was defined as the presence of either no injury or a neural injury on Magnetic Resonance Imaging (MRI) in the absence of radiographic or Computed Tomographic (CT) Scan findings suggestive of trauma in patients with neurological deficit. Purely extra neural compressive lesions were excluded from the study.

Results: Twelve of ninety seven (12.4%) patients had a neural injury on MRI with normal radiographs and CT scan. These included cord contusion in five cases, cord edema in five cases and cord hemorrhage in two cases. Ten patients were managed conservatively and two patients with disc prolapse were managed surgically. All patients showed at least one ASIA Impairment Scale (AIS) grade improvement and three patients (25%) recovered completely.

Conclusions: Parenchymal spinal cord injury is the single most important determinant in the long term outcome of adult SCIWORA patients. Cord hemorrhage has the worst prognosis and cord edema has the best. Longitudinal signal extension and associated extra neural injuries are also associated with poorer outcomes. Cases with purely neural injuries can be managed conservatively, but associated extra neural injuries, especially disc prolapse and ligamentous instability, warrant surgical management.

Keywords: Post Traumatic Myelopathy; Spinal Cord Trauma; Computed tomography; Magnetic resonance imaging; SCIWORA.

No MeSH data available.


Related in: MedlinePlus

Algorithm for diagnosis of adult SCIWORA.
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Figure 1: Algorithm for diagnosis of adult SCIWORA.

Mentions: Using the criteria described by Pang et al, SCIWORA was defined as presence of either no lesion or a neural lesion on MRI in the setting of normal radiographs and CT scan in patients with neurological deficit [1]. Purely extra neural compressive lesions with no intra neural pathology were excluded from the study (Fig. 1).


Adult Spinal Cord Injury without Radiographic Abnormalities (SCIWORA): Clinical and Radiological Correlations.

Sharma S, Singh M, Wani IH, Sharma S, Sharma N, Singh D - J Clin Med Res (2009)

Algorithm for diagnosis of adult SCIWORA.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3318880&req=5

Figure 1: Algorithm for diagnosis of adult SCIWORA.
Mentions: Using the criteria described by Pang et al, SCIWORA was defined as presence of either no lesion or a neural lesion on MRI in the setting of normal radiographs and CT scan in patients with neurological deficit [1]. Purely extra neural compressive lesions with no intra neural pathology were excluded from the study (Fig. 1).

Bottom Line: Parenchymal spinal cord injury is the single most important determinant in the long term outcome of adult SCIWORA patients.Longitudinal signal extension and associated extra neural injuries are also associated with poorer outcomes.Cases with purely neural injuries can be managed conservatively, but associated extra neural injuries, especially disc prolapse and ligamentous instability, warrant surgical management.

View Article: PubMed Central - PubMed

Affiliation: Postgraduate Department of Orthopedics, Government Medical College, Jammu, India.

ABSTRACT

Background: This study is aimed to determine the clinical and radiological corellations of adult patients with Spinal Cord Injury Without Radiographic Abnormalities (SCIWORA).

Methods: The study population consisted of all adult patients with suspected cervical spine injury. SCIWORA was defined as the presence of either no injury or a neural injury on Magnetic Resonance Imaging (MRI) in the absence of radiographic or Computed Tomographic (CT) Scan findings suggestive of trauma in patients with neurological deficit. Purely extra neural compressive lesions were excluded from the study.

Results: Twelve of ninety seven (12.4%) patients had a neural injury on MRI with normal radiographs and CT scan. These included cord contusion in five cases, cord edema in five cases and cord hemorrhage in two cases. Ten patients were managed conservatively and two patients with disc prolapse were managed surgically. All patients showed at least one ASIA Impairment Scale (AIS) grade improvement and three patients (25%) recovered completely.

Conclusions: Parenchymal spinal cord injury is the single most important determinant in the long term outcome of adult SCIWORA patients. Cord hemorrhage has the worst prognosis and cord edema has the best. Longitudinal signal extension and associated extra neural injuries are also associated with poorer outcomes. Cases with purely neural injuries can be managed conservatively, but associated extra neural injuries, especially disc prolapse and ligamentous instability, warrant surgical management.

Keywords: Post Traumatic Myelopathy; Spinal Cord Trauma; Computed tomography; Magnetic resonance imaging; SCIWORA.

No MeSH data available.


Related in: MedlinePlus