0:01

I'd like to talk about an entity that we use,

0:04

the eponym SCIWORA.

0:07

SCIWORA stands for spinal cord injury without

0:11

radiographic abnormalities. In this case,

0:13

we're talking radiographic abnormalities from the

0:16

standpoint of the plane films and potentially the CT scan,

0:20

but not the MRI scan.

0:23

And that is the patients who, you know,

0:25

the plane films and the

0:27

CT don't show very much,

0:28

but the patient has significant

0:30

neurologic deficit.

0:31

This is an entity that is more commonly

0:33

seen in the pediatric population.

0:35

And if you have it identified in patients

0:39

less than eight years of age,

0:41

you do see that the patients have more likely to

0:44

have permanent deficits. In the elderly patient,

0:48

you may have the superimposition

0:49

of DJD and spinal stenosis,

0:52

which predisposes the spinal cord to injury.

0:56

When you look at patients who have SCIWORA negative plane

0:59

films, negative CT scan, and perform an MRI scan,

1:03

you see that 93% have abnormal scans.

1:07

So these are patients who have significant neurologic

1:10

deficits but a negative CT and plane film.

1:14

This cord injury on the MRI scan is usually due to either

1:18

contusion from the trauma or potentially

1:21

in a case of spinal stenosis,

1:24

you may have an ischemic injury to the spinal cord.

1:26

So this is a patient with a negative CT,

1:28

negative plane film,

1:30

and yet we have this segmental area where there's bright

1:32

signal intensity in the spinal cord on the T2-weighted

1:36

scan, and the patient has significant

1:38

neurologic deficits.

1:40

It usually is more common in a hyperextension than a

1:43

hyperflection injury or when the patient falls

1:47

forward and has frontal impact to the face.

1:51

When you look at the results of the patient's

1:55

neurologic status after the MRI scan,

1:59

what you see is that in those patients who have

2:02

complete transection of the spinal cord,

2:04

they're going to do really poorly.

2:06

So here's the complete transection cord disruption.

2:09

Those patients who have major hemorrhage, again,

2:12

do very poorly. This is the neurologic grading.

2:15

They're doing severe neurologic deficits

2:18

when you see major hemorrhage in the spinal cord.

2:21

If on the MRI scan you have minor hemorrhage,

2:24

it's sort of an intermediate zone here between the moderate

2:28

and severe deficits that are the sequela of the injury.

2:33

If the patient just has edema alone,

2:36

generally milder symptoms, and if there is a normal MRI scan,

2:40

even with normal MRI scan,

2:42

although you would expect that the

2:43

patient would get better just fine,

2:46

there are some patients who get into the severe neurologic

2:51

deficit that will then resolve over the course of time.

2:55

So MRI is quite useful in the patients

2:58

with SCIWORA in predicting

3:00

what the deficits are going to be long term at six months,

3:04

depending upon what we find on the MRI scan.

3:07

Let me just say in general,

3:09

that anytime you have a hemorrhagic

3:11

injury to the spinal cord,

3:13

it generally portends a poor prognosis as compared to non

3:18

hemorrhagic edematous injuries to the spinal cord.

Case 31 - Spinal Cord Injury Without Radiographic Abnormalities

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