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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

SCIWORA Syndrome: (Spinal Cord Injury w/o Radiologic Abnormality)



- Discussion:
    - occurs most often in pediatric population;
    - accounts for up to 2/3 of severe cervical injuries in children < 8 years of age;
    - inherent elasticity in pediatric cervical spine can allow severe spinal cord injury to occur in absence of x-ray findings;
    - causes
             - transverse atlantal ligament injury
             - fracture through the cartilaginous end plates (which are not visualized by x-rays), may be among the causes of this injury;
             - unrecognized interspinous ligamentous injury:
                    - in above 2 situations, flexion & extension views taken with pt awake and physician in attendance will demonstrate injury;
             - adult with acute traumatic disc prolapse
             - cervical spondylosis
                    - C-spine trauma occurs w/ hyperextension injury to spine w/ vertebral canal whose diameter is already comprimised by spondylosis;
                    - excessive anterior buckling of ligamentum flavum into canal already compromised by posterior vertebral body osteophytes
                            probably is cause of central cord syndrome:
                            - motor loss in arms > than in legs, & variable sensory loss;
                            - typically, pts are managed nonsurgically w/ orthosis, & their neurologic status is carefully monitored;

- Radiographs:
    - diagnosis of exclusion:
    - MRI may give a more anatomic diagnosis by showing hemorrhage or edema of the spinal cord;
    - pseudosubluxation: anterior displacement may be up to 4 mm;

- Treatment: spine is immobilized for one to three weeks



Spinal cord injury without radiographic abnormality in children--the SCIWORA syndrome.

Spinal cord injury without radiographic abnormality in children.

Spinal Injury with out osseous spine fracture.  



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 25, 2012 12:40 pm