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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.