SCIWORA Syndrome (Spinal Cord Injury without Radiologic Abnormality)
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Also called spinal cord injury without radiographic evidence of trauma (SCIWORET), spinal cord injury without CT evidence of trauma (SCIWOCTET), or spinal cord injury without neuroimaging abnormality (SCIWONA)
- SCIWORA occurs after trauma; it is an acute spinal cord injury (SCI) and nerve root trauma resulting in transient or permanent sensory, motor, or combined sensorimotor deficits.
- Neural injuries occur without a fracture or misalignment visible on imaging (x-ray, CT).
- SCIWORA has a broad presentation, from minor neurologic symptoms to complete quadriplegia.
- Variable: reported to be 19–34% of pediatric spinal cord injuries (1)
- Occurs in all populations—90% in pediatric patients (1)
- Bimodal: affects children <8 years old and adults >60 years old; rarely occurs between 16 and 36 years (2)
- There is no association between Chiari malformation type 1 and SCIWORA.
Etiology and Pathophysiology
- Trauma (3)
- Motor vehicle collision (MVC) (most common cause); either unrestrained passengers, pedestrians, or bicyclists struck by motor vehicles
- Sports-related injury
- Significant fall
- Child abuse
- Age: Pediatric patients have a higher incidence of SCIWORA than adults due to anatomic differences and increased mobility and flexibility (1,5).
- Horizontally oriented facet joints permit more translational motion in the coronal (AP) plane.
- Anterior wedging of vertebral bodies
- Ligament and joint capsule elasticity permits increased intersegmental movement and disc protrusion.
- In patients age <8 years, head size-to-trunk ratio is disproportionately large.
- Weaker nuchal musculature
- Uncovertebral joints are absent.
- Pseudosubluxation of C2 to C3
- Cervical: upper > lower
- Thoracic: protected and splinted by ribs preventing forced flexion and extension
- Lumbar: rare and usually fatal (1)