SCIWORA Syndrome (Spinal Cord Injury without Radiologic Abnormality)
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.
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–C3
- Cervical: upper > lower
- Thoracic: protected and splinted by ribs preventing forced flexion and extension
- Lumbar: rare and usually fatal (1)
There's more to see -- the rest of this topic is available only to subscribers.