Spinal Cord Injury Without Radiographic Abnormalities
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I'd like to talk about an entity that we use,
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the eponym SCIWORA.
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SCIWORA stands for spinal cord injury without
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radiographic abnormalities. In this case,
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we're talking radiographic abnormalities from the
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standpoint of the plane films and potentially the CT scan,
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but not the MRI scan.
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And that is the patients who, you know,
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the plane films and the
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CT don't show very much,
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but the patient has significant
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neurologic deficit.
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This is an entity that is more commonly
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seen in the pediatric population.
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And if you have it identified in patients
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less than eight years of age,
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you do see that the patients have more likely to
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have permanent deficits. In the elderly patient,
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you may have the superimposition
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of DJD and spinal stenosis,
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which predisposes the spinal cord to injury.
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When you look at patients who have SCIWORA negative plane
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films, negative CT scan, and perform an MRI scan,
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you see that 93% have abnormal scans.
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So these are patients who have significant neurologic
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deficits but a negative CT and plane film.
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This cord injury on the MRI scan is usually due to either
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contusion from the trauma or potentially
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in a case of spinal stenosis,
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you may have an ischemic injury to the spinal cord.
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So this is a patient with a negative CT,
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negative plane film,
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and yet we have this segmental area where there's bright
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signal intensity in the spinal cord on the T2-weighted
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scan, and the patient has significant
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neurologic deficits.
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It usually is more common in a hyperextension than a
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hyperflection injury or when the patient falls
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forward and has frontal impact to the face.
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When you look at the results of the patient's
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neurologic status after the MRI scan,
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what you see is that in those patients who have
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complete transection of the spinal cord,
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they're going to do really poorly.
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So here's the complete transection cord disruption.
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Those patients who have major hemorrhage, again,
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do very poorly. This is the neurologic grading.
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They're doing severe neurologic deficits
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when you see major hemorrhage in the spinal cord.
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If on the MRI scan you have minor hemorrhage,
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it's sort of an intermediate zone here between the moderate
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and severe deficits that are the sequela of the injury.
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If the patient just has edema alone,
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generally milder symptoms, and if there is a normal MRI scan,
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even with normal MRI scan,
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although you would expect that the
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patient would get better just fine,
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there are some patients who get into the severe neurologic
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deficit that will then resolve over the course of time.
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So MRI is quite useful in the patients
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with SCIWORA in predicting
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what the deficits are going to be long term at six months,
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depending upon what we find on the MRI scan.
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Let me just say in general,
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that anytime you have a hemorrhagic
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injury to the spinal cord,
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it generally portends a poor prognosis as compared to non
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hemorrhagic edematous injuries to the spinal cord.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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