https://doi.org/10.4081/ecj.2023.11233
Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case report and literature review
Submitted: 2 February 2023
Accepted: 11 April 2023
Published: 23 June 2023
Accepted: 11 April 2023
Abstract Views: 1223
PDF: 370
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Spinal cord injury without radiographic abnormality (SCIWORA) is a rare post-traumatic myelopathy, more frequently seen in paediatric population and elderly. Clinical manifestation can range from transient isolated paraesthesia to quadriplegia. Due to its rarity in adults and the broad spectrum of neurological manifestations, SCIWORA actually represents a challenge for emergency physicians. Early diagnosis and timely intervention are crucial for the patient’s prognosis avoiding permanent neurological deficits. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnosis, management and prognosis of SCIWORA, being the golden standard technique to identify spinal cord injuries. To highlight the importance of in-depth neurological examination and early diagnosis of SCIWORA, we describe the case of a 53-year-old woman who presented to our emergency department following a forward fall down the stairs with a minor head injury.
American Spinal Injury Association. International Standards for Neurological Classification of SCI (ISNCSCI) Worksheet. Accessed January 22, 2023. Available from: https://asia-spinalinjury.org/international-standards-neurological-classification-sci-isncsci-worksheet/
Advanced Life Support Group. Advanced paediatric life support. 2nd ed. London: BMJ Publishing Group, 1997:174.
Pang D, Wilberger JE Jr. Spinal cord injury without radiographic abnormalities in children. J Neurosurg 1982;57:114–29.
DOI: https://doi.org/10.3171/jns.1982.57.1.0114
Wyndaele JJ. SCIWORA. Spinal Cord 2016;54:755.
DOI: https://doi.org/10.1038/sc.2016.141
Choi JU, Hoffman HJ, Hendrick EB, et al. Traumatic infarction of the spinal cord in children. J Neurosurg 1986;65:608-10.
DOI: https://doi.org/10.3171/jns.1986.65.5.0608
Hill SA, Miller CA, Kosnik EJ, Hunt WE. Paediatric neck injuries: A clinical study. J Neurosurg 1984;60:700-6.
DOI: https://doi.org/10.3171/jns.1984.60.4.0700
Ruge JR, Sinson GP, McLone DG, Cerullo LJ. Paediatric spinal injury: the very young. J Neurosurg 1988;68:25-30.
DOI: https://doi.org/10.3171/jns.1988.68.1.0025
Kumar R, Lim J, Mekary RA, et al. Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg 2018;113:e345-e363.
DOI: https://doi.org/10.1016/j.wneu.2018.02.033
Carroll T, Smith CD, Liuetal X. Spinal cord injuries without radiologic abnormality in children: A systematic review. Spinal Cord 2015;53:842-8.
DOI: https://doi.org/10.1038/sc.2015.110
Guo H, Liu J, Qi X, et al. Epidemiological characteristics of adult SCIWORA in Tianjin, China: a preliminary study Eur Spine J 2012;21(1):165-171. Corrections in Eur Spine J 2012;21:562.
DOI: https://doi.org/10.1007/s00586-011-2041-x
Kothari P, Freeman B, Grevitt M, Kerslake R. Injury to the spinal cord without radiological abnormality (SCIWORA) in adults. J Bone Joint Surg Br 2000;82:1034-7.
DOI: https://doi.org/10.1302/0301-620X.82B7.0821034
Gupta SK, Rajeev K, Khosla VK, et al. Spinal cord injury without radiographic abnormality in adults. Spinal Cord 1999;37:726-9.
DOI: https://doi.org/10.1038/sj.sc.3100900
Kasimatis GB, Panagiotopoulos E, Megas P, et al. The adult spinal cord injury without radiographic abnormalities syndrome: magnetic resonance imaging and clinical findings in adults with spinal cord injuries having normal radiographs and computed tomography studies. J Trauma 2008;65:86-93.
DOI: https://doi.org/10.1097/TA.0b013e318157495a
McCall T, Fassett D, Brockmeyer D. Cervical spine trauma in children: a review. Neurosurgical Focus 2006;20:e5.
DOI: https://doi.org/10.3171/foc.2006.20.2.6
Dickman CA, Zabramski JM, Hadley MN, Rekate HL, Sonntag VK. Pediatric spinal cord injury without radiographic abnormalities: report of 26 cases and review of the literature. J Spinal Disord 1991;4:296-305.
DOI: https://doi.org/10.1097/00002517-199109000-00006
Pang D, Pollack IF. Spinal cord injury without radiographic abnormality in children: the SCIWORA syndrome. J Trauma 1989;29:654–64.
DOI: https://doi.org/10.1097/00005373-198905000-00021
Martinez-Perez R, Munarriz PM, Paredes I, et al. Cervical spinal cord injury without computed tomography evidence of trauma in adults: magnetic resonance imaging prognostic factors. World Neurosurg 2017;99:192-9.
DOI: https://doi.org/10.1016/j.wneu.2016.12.005
Khatri K, Farooque K, Gupta A, Sharma V. Spinal cord injury without radiological abnormality in adult thoracic spinal trauma. Arch Trauma Res 2014;3:e19036.
DOI: https://doi.org/10.5812/atr.19036
Van Buul G, Oner FC. Thoracic spinal cord injury without radiographic abnormality in an adult patient. Spine J 2009;9:e5-e8.
DOI: https://doi.org/10.1016/j.spinee.2008.03.003
Knox J. Epidemiology of spinal cord injury without radiographic abnormality in children: a nationwide perspective. J Child Orthop 2016;10:255-60.
DOI: https://doi.org/10.1007/s11832-016-0740-x
Rekate HL, Theodore N, Sonntag VK, Dickman CA. Pediatric spine and spinal cord trauma. State of the art for the third millennium. Childs Nerv Syst 1999;15:743-50.
DOI: https://doi.org/10.1007/s003810050464
Ergun A, Oder W. Pediatric care report of spinal cord injury without radiographic abnormality (SCIWORA): case report and literature review. Spinal Cord 2003;41:249-53.
DOI: https://doi.org/10.1038/sj.sc.3101442
Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery 2004;55:1325-42.
DOI: https://doi.org/10.1227/01.NEU.0000143030.85589.E6
Atesok K, Tanaka N, Theiss S, et al. Posttraumatic spinal cord injury without radiographic abnormality. Adv Orthopaedics 2018;4:7060654.
DOI: https://doi.org/10.1155/2018/7060654
Lee CC, Lee SH, Yo CH, et al. Complete recovery of spinal cord injury without radiographic abnormality and traumatic brachial plexopathy in a young infant falling from a 30-feet-high window. Pediatr Neurosurg 2006;42:113-5.
DOI: https://doi.org/10.1159/000090466
Ahmann PA, Smith SA, Schwartz JF, Clark DB. Spinal cord infarction due to minor trauma in children. Neurology 1975;25:301-7.
DOI: https://doi.org/10.1212/WNL.25.4.301
Launay F, Leet AI, Sponseller PD. Pediatric spinal cord injury without radiographic abnormality: a meta-analysis. Clin Orthop Relat Res 2005;433:166-70.
DOI: https://doi.org/10.1097/01.blo.0000151876.90256.bf
Brown RL, Brunn MA, Garcia VF. Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 2001;36:1107-14.
DOI: https://doi.org/10.1053/jpsu.2001.25665
Imajo Y, Hiiragi I, Kato Y, Taguchi T. Use of the finite element method to study the mechanism of spinal cord injury without radiological abnormality in the cervical spine. Spine (Phila Pa 1976) 2009;34:E83-7.
DOI: https://doi.org/10.1097/BRS.0b013e31818a2c30
Levitt MA, Flanders AE. Diagnostic capabilities of magnetic resonance imaging and computed tomography in acute cervical spinal column injury. Am J Emerg Med 1991;9:131-5.
DOI: https://doi.org/10.1016/0735-6757(91)90173-H
Matsumura A, Meguro K, Tsurushima H, et al. Magnetic resonance imaging of spinal cord injury without radiographic abnormality. Surg Neurol 1991;33:281-3.
DOI: https://doi.org/10.1016/0090-3019(90)90049-U
Mirvis SE, Geisler FH, Jelinek JJ, et al. Acute cervical spine trauma: Evaluation with 1.5 T MR imaging. Radiology 1988;166:307-16.
DOI: https://doi.org/10.1148/radiology.166.3.3277249
Crooks F, Birkett AN. Fractures and dislocations of the cervical spine. Br J Surg 1944;31:252-65.
DOI: https://doi.org/10.1002/bjs.18003112309
Szwedowski D, Walecki J. Spinal Cord Injury without Radiographic Abnormality (SCIWORA) - clinical and radiological aspects. Pol J Radiol 2014;79:461-4.
DOI: https://doi.org/10.12659/PJR.890944
Bonfanti L, Donelli V, Lunian M, et al. Adult Spinal Cord Injury Without Radiographic Abnormality (SCIWORA). Two case reports and a narrative review. Acta Biomed 2019;89:593-8.
Sharma S, Singh M, Wani IH, et al. Adult Spinal Cord Injury without Radiographic Abnormalities (SCIWORA): Clinical and Radiological Correlations. J Clin Med Res 2009;1:165-72.
DOI: https://doi.org/10.4021/jocmr2009.08.1256
Ramrattan NN, Oner FC, Boszczyk BM, et al. Cervical spine injury in the young child. Eur Spine J 2012;21:2205-11.
DOI: https://doi.org/10.1007/s00586-012-2292-1
West OC, Anbari MM, Pilgram TK, Wilson AJ. Acute cervical spine trauma: diagnostic performance of single-view versus three-view radiographic screening. Radiology 1997;204:819-23.
DOI: https://doi.org/10.1148/radiology.204.3.9280266
Pollack CV Jr, Hendey GW, Martin DR, et al. Use of flexion-extension radiographs of the cervical spine in blunt trauma. Ann Emerg Med 2001;38:8-11.
DOI: https://doi.org/10.1067/mem.2001.116810
Grabb PA, Pang D. Magnetic resonance imaging in the evaluation of spinal cord injury without radiographic abnormality in children. Neurosurgery 1994;35:406-14.
DOI: https://doi.org/10.1097/00006123-199409000-00007
Parizel PM, van der Zijden T, Gaudino S, et al. Trauma of the spine and spinal cord: imaging strategies. Eur Spine J 2010;19:S8-S17.
DOI: https://doi.org/10.1007/s00586-009-1123-5
Boese CK, Müller D, Bröer R, et al. Spinal cord injury without radiographic abnormality (SCIWORA) in adults: MRI type predicts early neurologic outcome. Spinal Cord 2016;54:878-83.
DOI: https://doi.org/10.1038/sc.2016.13
Rozzelle CJ, Aarabi B, Dhall SS, et al. Spinal cord injury without radiographic abnormality (SCIWORA). Neurosurgery 2013;72:227-33.
DOI: https://doi.org/10.1227/NEU.0b013e3182770ebc
Yucesoy K, Yuksel KZ. SCIWORA in MRI era. Clin Neurol Neurosurg 2008;110:429-33.
DOI: https://doi.org/10.1016/j.clineuro.2008.02.004
Shen H, Tang Y, Huang L, et al. Applications of diffusion-weighted MRI in thoracic spinal cord injury without radiographic abnormality. Int Orthop 2007;31:375-83.
DOI: https://doi.org/10.1007/s00264-006-0175-y
Yaqoob Hakim S, Gamal Altawil L, Faidh Ramzee A, et al. Diagnosis, management and outcome of Spinal Cord Injury without Radiographic Abnormalities (SCIWORA) in adult patients with trauma: a case series. Qatar Med J 2021;2021:67.
DOI: https://doi.org/10.5339/qmj.2021.67
Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomised Control Trial. National Acute Spinal Cord Injury Study. JAMA 1997;277:1597–604.
DOI: https://doi.org/10.1001/jama.277.20.1597
Crawford S, Bleetman T. Adult spinal cord injury without radiological abnormality. J Accid Emerg Med 2000;17:374-5.
DOI: https://doi.org/10.1136/emj.17.5.374
How to Cite
Morelli, N., Poggiali, E., Ioannilli, E., De Mitri, P., Corvi, A., Cervellin, G., & Vercelli, A. (2023). Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case report and literature review. Emergency Care Journal, 19(2). https://doi.org/10.4081/ecj.2023.11233
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
