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.

7. 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.

8. 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.

9. 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

10. THANK YOU