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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

(a) T2W saggital MR image of a 22 year old male showing cord contusion at C6-7 level and disc bulging at C3-4 and C6-7 levels. (b) T2W saggital MR image of the same patient done after one year. Note the focal myelomalacia at C6-7 level.
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Figure 7: (a) T2W saggital MR image of a 22 year old male showing cord contusion at C6-7 level and disc bulging at C3-4 and C6-7 levels. (b) T2W saggital MR image of the same patient done after one year. Note the focal myelomalacia at C6-7 level.

Mentions: Follow-up MRI after one year of injury were done in two cases of cord contusion. One was a 29 years old male with cord contusion opposite C6-7 levels and multiple level disc bulges (Fig. 7a). At one year of follow-up, repeat MRI showed that the contusion had significantly decreased in size and there was no myelomalacia (Fig. 7b). This patient improved from AIS B to AIS D. The other case was that of a 22 years old with cord contusion opposite C6-7 and disc bulges at two levels (Fig. 8a). Repeat MRI after one year showed focal myelomalacia at C6-7 level (Fig. 8b). He had complete cord injury at presentation (AIS A) and improved only to AIS C. The average duration of follow-up was 2.0 years (1.2 - 3 years).


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)

(a) T2W saggital MR image of a 22 year old male showing cord contusion at C6-7 level and disc bulging at C3-4 and C6-7 levels. (b) T2W saggital MR image of the same patient done after one year. Note the focal myelomalacia at C6-7 level.
© Copyright Policy - open access
Related In: Results  -  Collection

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

Figure 7: (a) T2W saggital MR image of a 22 year old male showing cord contusion at C6-7 level and disc bulging at C3-4 and C6-7 levels. (b) T2W saggital MR image of the same patient done after one year. Note the focal myelomalacia at C6-7 level.
Mentions: Follow-up MRI after one year of injury were done in two cases of cord contusion. One was a 29 years old male with cord contusion opposite C6-7 levels and multiple level disc bulges (Fig. 7a). At one year of follow-up, repeat MRI showed that the contusion had significantly decreased in size and there was no myelomalacia (Fig. 7b). This patient improved from AIS B to AIS D. The other case was that of a 22 years old with cord contusion opposite C6-7 and disc bulges at two levels (Fig. 8a). Repeat MRI after one year showed focal myelomalacia at C6-7 level (Fig. 8b). He had complete cord injury at presentation (AIS A) and improved only to AIS C. The average duration of follow-up was 2.0 years (1.2 - 3 years).

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