Spinal Cord Injury Without Radiographic Abnormality

Abstract

Spinal cord injury without radiographic abnormality (SCIWORA) is a syndrome characterized by clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability; it is responsible for up to 20% of spinal cord injuries in children (mostly aged less than 10 years of age).

The injury of the spinal cord seen in SCIWORA syndrome is caused by a contusion or ischemia of the cord due to temporary occlusion of vertebral arteries, followed by a spontaneous return of vertebrae to their original position.

The two main predictors of prognosis after SCIWORA are the initial neurological status and MRI findings. Improvement of neurological symptoms following conservative treatment should be expected in patients with incomplete neurological injury (absence of osseous lesions and instability); patients with instability or anatomical transection of the spinal cord (complete neurological deficit at initial presentation) have the poorest prognosis with permanent neurologic deficits.