Spinal Cord Injury Without Radiology Abnormality (SCIWORA)

Spinal Cord Injury Without Radiology Abnormality (SCIWORA)

1. spinal cord injury without radiographic abnormality  (SCIWORA) Ade Wijaya, MD – October 2020

2. Outline: Introduction Pathophysiology Diagnosis Treatment Prognosis Summary

3. Introduction A rare traumatic myelopathy without any evidence of vertebral fracture or malalignment on plain radiographs or computed tomography ( CT ) First reported in 1989 Mainly affected the cervical spine and was associated with a wide range of movements in the cervical spine, among which C3-4 and C5-6 were vulnerable segments   The most common injury mechanisms of SCIWORA are hyperextension, flexion, and distraction of the head Qi C, Xia H, Miao D, Wang X, Li Z. The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA). Journal of orthopaedic surgery and research. 2020 Dec;15(1):1-8.

4. Pathophysiology Cervical spinal stenosis before trauma, such as cervical disc herniation, ossification of posterior longitudinal ligament, and calcification of ligamentum flavum, is closely related to the mechanism of SCIWORA Patients with soft tissue injuries, such as anterior longitudinal ligament or ligamentum flavum injury, show less ability to improve The external force reduces the storage capacity of the cervical spinal canal and compresses the spinal cord Qi C, Xia H, Miao D, Wang X, Li Z. The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA). Journal of orthopaedic surgery and research. 2020 Dec;15(1):1-8.

5. Diagnosis MRI has become a golden standard for diagnosing the Spinal cord injury (SCI). Early MRI examinations in a SCI within 3 days are difficult to fully find the signal, which may lead to misdiagnosis or missed diagnosis.   Qi C, Xia H, Miao D, Wang X, Li Z. The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA). Journal of orthopaedic surgery and research. 2020 Dec;15(1):1-8.

6. Treatment Non surgical: steroid therapy, fixation, and most importantly, avoiding activities that may increase the risk of secondary injury Surgical (at 3 - 7 days onset) Qi C, Xia H, Miao D, Wang X, Li Z. The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA). Journal of orthopaedic surgery and research. 2020 Dec;15(1):1-8.

7. Prognosis The prognosis of SCIWORA also depends on the degree of initial neurological impairment and SCI revealed by MRI The prognosis of spinal cord edema is better than that of spinal cord hemorrhage. Qi C, Xia H, Miao D, Wang X, Li Z. The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA). Journal of orthopaedic surgery and research. 2020 Dec;15(1):1-8.

8. Summary Diagnostic gold standard: MRI The incidence of complications in premature surgery increased, and the surgical decompression range was affected The optimal timing of surgical treatment is 3–7 days after injury, which can significantly improve the short-term and long-term follow-up effects

9. THANK YOU