Spinal cord injury without radiographic abnormality (SCIWORA) is symptoms of a

spinal cord injury A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. It is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions. Symptoms of ...

(SCI) with no evidence of injury to the

spinal column The spinal column, also known as the vertebral column, spine or backbone, is the core part of the axial skeleton in vertebrates. The vertebral column is the defining and eponymous characteristic of the vertebrate. The spinal column is a segmen ...

X-rays An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

. Symptoms may include

numbness Hypoesthesia or numbness is a common side effect of various medical conditions that manifests as a reduced sense of touch or sensation, or a partial loss of sensitivity to Sensory receptor, sensory stimuli. In everyday speech this is generally r ...

, weakness, abnormal

reflexes In biology, a reflex, or reflex action, is an involuntary, unplanned sequence or action and nearly instantaneous response to a Stimulus (physiology), stimulus. Reflexes are found with varying levels of complexity in organisms with a nervous s ...

, or loss of bladder or bowel control. Neck or back pain is also common. Symptoms may be brief or persistent. Some do not develop symptoms until a few days after the injury. Causes may include

motor vehicle collisions A traffic collision, also known as a motor vehicle collision, or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, pole or building. Tr ...

, falls, sports injuries, and non accidental trauma. A number of underlying mechanisms are proposed including spinal cord contusion, injury to the blood supply to the spinal cord, and excessive stretching of the cord.

Magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and ...

(MRI) is recommended to determine if further problems are present. Treatment is often based on the MRI findings and whether or not symptoms are persistent. If the MRI is normal and symptoms have resolved no or brief neck bracing may be recommended. Otherwise a rigid

cervical collar A cervical collar, also known as a neck brace, is a medical device used to support and immobilize a person's neck. It is also applied by emergency personnel to those who have had traumatic head or neck injuries, although they should not be rou ...

or surgery to immobilize the neck for three months is recommended. If the MRI is abnormal surgery to hold the neck still may be carried out Typically people should avoid further high risk activities for the next six months. The use of

corticosteroids Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invol ...

is not generally recommended. The condition is rare. Most cases are believed to occur in children and the elderly. Males are more frequently affected than females. Outcomes are generally good if the MRI is normal but less so if problems are found. The risk of death is low at about 2%. It was first defined in 1982.

Signs and symptoms

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. Notably, the clinical symptoms can present with a delay of hours to days after the trauma. This phenomenon was primarily seen in children but was reported in adults as well. The duration of symptoms varies widely. A full recovery can be achieved without treatment within minutes to hours and permanent injuries might prevail. Overall, there seems to be a relation between extent of damage to the spinal cord and the clinical prognosis. The prognostic value of intra- and extra-medullary MRI findings is subject of ongoing research in the field of SCIWORA.

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. Boese and Lechler proposed an MRI-based classification for SCIWORA which correlated with the neurological outcome:

History

The acronym SCIWORA was coined by Pang and Wilderer in 1982 This first description of spinal cord injuries with clinical-radiological mismatch was followed by a large number of case reports and case series. Later, a similar condition was reported in adults. It is most common in children. 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. SCI in adults could be due to instability of vertebral ligaments or a

hernia A hernia (: hernias or herniae, from Latin, meaning 'rupture') is the abnormal exit of tissue or an organ (anatomy), organ, such as the bowel, through the wall of the cavity in which it normally resides. The term is also used for the normal Devel ...

tion of a disk or a

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is ...

around the spinal cord that presses on it—none of which would show up on X-rays. In older people,

spondylosis Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense, it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degener ...

or problems with blood vessels can cause SCIWORA. The most common cause is being hit by a vehicle while on foot. Before 1982, the phenomenon of clinics-radiological mismatch was known as well. Historical literature regarding spinal cord concussion, spinal cord contusion and hyperextension/hyperflexion injuries to the spine describe similar cases to modern cases of SCIWORA. After the introduction of SCIWORA, the term was expanded to adults presenting with degenerative changes. Some authors used the term spinal cord injury without radiographic evidence of trauma (SCIWORET) to describe these cases. Furthermore, the introduction of computed tomography enabled a more detailed depiction of the spine. Thus, the identification of injuries previously missed called for a delimitation from the classical SCIWORA and SCIWORET. The term SCIWOCTET (spinal cord injury without CT evidence of trauma) was introduced by Martinez-Perez. Finally, the use of magnetic resonance imaging (MRI) allowed for even better depiction of the spine and soft tissue abnormalities in particular. Again, a novel acronym was proposed to classify patients without traumatic signs using radiographs, CT and MRI. The term spinal cord injury without neuroimaging abnormality (SCIWONA) was used. However, the novel acronyms were not generally accepted and the more general term SCIWORA is usually used to describe all variants of clinico-radiological mismatches.

References

External links

{{Medical resources , ICD10 = , ICD9 = , ICDO = , OMIM = , DiseasesDB = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeSH = , GeneReviewsNBK = , GeneReviewsName = , Orphanet = Neurotrauma Wikipedia medicine articles ready to translate