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Meira Goncalves J, Carvalho S, Silva AI, Pereira J, Polónia P. Real Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) in Pediatrics: A Clinical Case Report and Literature Review. Cureus 2023; 15:e50491. [PMID: 38222116 PMCID: PMC10787207 DOI: 10.7759/cureus.50491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Spinal cord injury without radiological abnormality (SCIWORA) was first reported in 1974. The term was used to define "clinical symptoms of traumatic myelopathy without signs of fracture or spine instability on X-ray or CT scan." With the emergence of MRI, the gold standard method to identify spinal cord injuries, about two-thirds of former SCIWORA cases were found to have pathological findings, and, as such, the term has taken on an ambiguous meaning in the literature. We describe the clinical case of a 17-year-old boy who was admitted to the emergency department of a tertiary hospital after a fall during a soccer game. He suffered spinal and cranioencephalic trauma. A few minutes later, the boy began to show decreased strength in the right upper limb and lower limbs, as well as changes in sensation in the right hemibody. On objective examination, the boy presented a Glasgow Coma Scale score of 15 and the American Spinal Injury Association Impairment Scale D, with partial improvement of initial symptoms of monoparesis of the right lower limb. There were no other changes, specifically at the sensory level. The patient underwent a CT and MRI of the spine that showed no fractures, instability, or appreciable medullary signal changes. Electromyography was normal. Based on the clinical history and imaging findings, real SCIWORA was diagnosed. The patient was admitted to an inpatient rehabilitation program. At a follow-up visit two months later, a complete reversal of signs and symptoms was confirmed. The prognosis of this pathology depends on the extent of the spinal cord injury, as evidenced by MRI. Although neurological improvement when severe deficit is present at initial presentation is unlikely, most patients with incomplete neurological damage show good recovery. The absence of visible changes on MRI is associated with a better prognosis.
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Affiliation(s)
| | - Sara Carvalho
- Neuroradiology, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Ana Isabel Silva
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Josué Pereira
- Neurosurgery, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Patricia Polónia
- Neurosurgery, Centro Hospitalar Universitário de São João, Porto, PRT
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Basile G, Fozzato S, Petrucci QA, Gallina M, Accetta R, Passeri A, Bianco Prevot L, Marinelli E. Spinal cord injuries in the absence of post-traumatic radiographic anomalies (SCIWORA): the traumatic moment between patient anterior state and efficient/concurrent causes of injury. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023066. [PMID: 36786248 PMCID: PMC9987477 DOI: 10.23750/abm.v94i1.14146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM Spinal Cord Injury without Radiographic Abnormality (SCIWORA) represents acute traumatic myelopathy in the absence of instrumental evidence of fractures and/or dislocations of the cervical vertebrae. METHODS In this article we present 4 cases of SCIWORA that came to our observation and the medico-legal implications associated with them. RESULTS In defining the compensation in the context of a private accident policy for traumatic pathologies of the spinal cord, an in-depth medical-legal assessment is essential, based on an accurate examination of the health documentation including the instrumental investigations performed, the anamnesis and an accurate evaluation of the trauma dynamic. The paraphysiological deterioration of organ-tissue structures, identifiable in the concept of "natural variability of biological risk", should be included in the same definition of insured risk by age group, with the consequence that physical conditions that fall within the physiological or paraphysiological definitions, although potentially contributing to injury, do not necessarily exclude compensation. A different concept dominates the variability of the compensation according to a paraphysiological pre-existing condition. The two arguments therefore call for thorough consideration of both the paraphysiological contributing causes of injury and/or impairment as necessarily subject to a preliminary study, which through the clinical and instrumental investigation method, will define the perimeter of functionality.
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Affiliation(s)
- Giuseppe Basile
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute.
| | - Stefania Fozzato
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy.
| | - Quirino Alessandro Petrucci
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - Mario Gallina
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy.
| | - Riccardo Accetta
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy.
| | | | - Luca Bianco Prevot
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy.
| | - Enrico Marinelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
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Yaqoob Hakim S, Gamal Altawil L, Faidh Ramzee A, Asim M, Ahmed K, Awwad M, El-Faramawy A, Mollazehi M, El-Menyar A, Ellabib M, Al-Thani H. Diagnosis, management and outcome of Spinal Cord Injury without Radiographic Abnormalities (SCIWORA) in adult patients with trauma: a case series. Qatar Med J 2021; 2021:67. [PMID: 34888203 PMCID: PMC8628129 DOI: 10.5339/qmj.2021.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Spinal cord injury without radiographic abnormality (SCIWORA) in adults causes diagnostic and prognostic dilemma as radiography and/or computed tomography does not clearly detect bone lesions during the initial assessment. Herein, we report our experience on 11 spinal cord injury cases without radiographic abnormality, regarding the clinicoradiological features, management, and outcomes. Methods: We conducted a case series of adult patients with SCIWORA who were admitted at the level 1 trauma center at Hamad General Hospital from January 2008 to July 2018. All patients underwent initial head and spine X-ray imaging, computed tomography, magnetic resonance imaging, and 12 months of clinical follow-up. Results: Eleven patients (mean age, 46.5 ± 14.4 years) met the criteria of SCIWORA. The neurologic status on admission and 12 months after hospital discharge were classified according to the American Spinal Injury Association (ASIA) impairment scale (AIS). On admission, 6 (54.5%) patients had ASIA grade C: 2 (18.2%) each had AIS grade D and B and 1 (9.1%) had AIS grade A. Five cases were treated conservatively with rehabilitation and physiotherapy, and five were treated surgically by anterior cervical discectomy with fusion. One patient who declined surgery was managed with a sternal occipital mandibular immobilizer brace and underwent rehabilitation. Conclusion: SCIWORA requires higher clinical suspicion and thorough neurological and radiologic assessment to prevent secondary spinal cord injuries and complications.
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Affiliation(s)
- Suhail Yaqoob Hakim
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar E-mail:
| | | | - Ahmed Faidh Ramzee
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar E-mail:
| | - Mohammad Asim
- Department of Surgery, Trauma surgery Section, Clinical research, HGH, Doha, Qatar
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar E-mail:
| | - Motasem Awwad
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar E-mail:
| | - Ahmed El-Faramawy
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar E-mail:
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery Section, Qatar Trauma registry, HGH, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma surgery Section, Clinical research, HGH, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | | | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar E-mail:
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Identification of clinical and radiographic predictors of central nervous system injury in genetic skeletal disorders. Sci Rep 2021; 11:11402. [PMID: 34059710 PMCID: PMC8166875 DOI: 10.1038/s41598-021-87058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Some studies report neurological lesions in patients with genetic skeletal disorders (GSDs). However, none of them describe the frequency of neurological lesions in a large sample of patients or investigate the associations between clinical and/or radiological central nervous system (CNS) injury and clinical, anthropometric and imaging parameters. The project was approved by the institution’s ethics committee (CAAE 49433215.5.0000.0022). In this cross-sectional observational analysis study, 272 patients aged four or more years with clinically and radiologically confirmed GSDs were prospectively included. Genetic testing confirmed the diagnosis in the FGFR3 chondrodysplasias group. All patients underwent blinded and independent clinical, anthropometric and neuroaxis imaging evaluations. Information on the presence of headache, neuropsychomotor development (NPMD), low back pain, joint deformity, ligament laxity and lower limb discrepancy was collected. Imaging abnormalities of the axial skeleton and CNS were investigated by whole spine digital radiography, craniocervical junction CT and brain and spine MRI. The diagnostic criteria for CNS injury were abnormal clinical and/or radiographic examination of the CNS. Brain injury included malacia, encephalopathies and malformation. Spinal cord injury included malacia, hydrosyringomyelia and spinal cord injury without radiographic abnormalities. CNS injury was diagnosed in more than 25% of GSD patients. Spinal cord injury was found in 21.7% of patients, and brain injury was found in 5.9%. The presence of low back pain, os odontoideum and abnormal NPMD remained independently associated with CNS injury in the multivariable analysis. Early identification of these abnormalities may have some role in preventing compressive CNS injury, which is a priority in GSD patients.
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Martinez-Perez R, Joswig H, Rayo N, Bertazzo-Silveira G. Spinal Cord Injury Without Radiological Abnormalities and the importance of Magnetic Resonance. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020084. [PMID: 32921780 PMCID: PMC7716950 DOI: 10.23750/abm.v91i3.8518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/24/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Rafael Martinez-Perez
- Department of Neurological Sciences, Wexner Medical Center, The Ohio State University.
| | - Holger Joswig
- HMU Health and Medical University Potsdam, Department of Neurosurgery, Ernst von Bergmann Hospital, Potsdam, Germany.
| | - Natalia Rayo
- Department of Biology, University of Western Ontario, London, Ontario, Canada.
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