Tetraparesis due to spinal cord injury without radiological abnormality in adults

Authors

  • Muhammad Anggawiyatna Department of Orthopaedic & Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • S. Dohar AL Tobing Department of Orthopaedic & Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Keywords:

SCIWORA, adult, tetraparesis, MRI, radiography, external immobilization

Abstract

Introduction: Spinal cord injury without radiological abnormality (SCIWORA) is definedas spinal cord injury with no evidence of vertebral fractures or malalignment on radiographs or CT.SCIWORA is commonly seen in paediatric population, while only very few cases have been reported in adults.We report a case of SCIWORA to improve our understanding regarding the pathophysiology of SCIWORA, current diagnostic options, and also treatment options available.

Methods:

We report a case of a 49 year old male with tetraparesisafter fell from 3 meters height. Physical examination founddecreased sensation below the C5 dermatome level, with motoric weakness at both upper and lower extremities. Radiographs and CT showed no fractures or dislocation. MRI suggested that there was myelitis of intramedullary spinal on the C4 level. Conservative treatment was done by using hard collar neck for immobilization together with painkiller and neuroprotector administration.

Results:

Spinal trauma patients exhibitingneurological deficit but no radiological abnormality should be treated as a case of SCIWORA. SCIWORAis caused by a contusion or ischemia, followed by a spontaneous return of vertebrae to their original position.The principal treatment has been immobilization and avoidance of high-risk activities.The conservative treatment that was done to our patient gave satisfying outcomes (return of sensorics and improve motor functions 4/4).

Conclusion:

SCIWORA is not uncommon in adults.MRI was used as a diagnostic investigation method for spinal trauma, but there are currently no consensus of diagnostic criteria for classifying cases as SCIWORA. External immobilization of the spinal segment of injury is recommended for up to 12 weeks.

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References

Rozzelle CJ, Aarabi B, Dhall SS, et al. Spinal cord injury without radiographic abnormality (SCIWORA). Neurosurgery. 2013;72(SUPPL.2):227-233. doi:10.1227/ NEU.0b013e3182770ebc.

Walecki J. Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) – Clinical and Radiological Aspects. Polish J Radiol. 2014;79:461-464. doi:10.12659/ PJR.890944.

Como JJ, Samia H, Nemunaitis GA, et al. The misapplication of the term spinal cord injury without radiographic abnormality (SCIWORA) in adults. J Trauma Acute Care Surg. 2012;73(5):1261-1266. doi:10.1097/ TA.0b013e318265cd8c.

Buldini B, Amigoni A, Faggin R, Laverda AM. Spinal cord injury without radiographic abnormalities. Eur J Pediatr. 2006;165(2):108-111. doi:10.1007/s00431-005-0004-0.

Epstein N, Hollingsworth R. Diagnosis and management of traumatic cervical central spinal cord injury: A review. Surg Neurol Int. 2015;6(5):140. doi:10.4103/2152- 7806.156552.

Khatri K, Farooque K, Gupta A, Sharma V. Spinal Cord Injury Without Radiological Abnormality Following Trauma to Thoracic Spine in an Adult Patient: A Case Report and Literature Review. Arch Trauma Res. 2014;3(3). doi:10.5812/atr.19036.

Hadley MN. Spinal Cord Injury without Radiographic Abnormality RECOMMENDATIONS DIAGNOSIS : Standards : TREATMENT : PROGNOSIS. Neurosurgery. 2002;50(3):100-104. http://www.ncbi.nlm.nih.gov/ pubmed/12431293.

Mohanty SP, Bhat NS, Singh KA, Bhushan M. Cervical spinal cord injuries without radiographic evidence of trauma: A prospective study. Spinal Cord. 2013;51(11):815-818. doi:10.1038/sc.2013.87.

Yucesoy K, Yuksel KZ. SCIWORA in MRI era. Clin Neurol Neurosurg. 2008;110(5):429-433. doi:10.1016/j. clineuro.2008.02.004.

Neva MH, Roeder CP, Felder U, et al. Neurological outcome, working capacity and prognostic factors of patients with SCIWORA. Spinal Cord. 2012;50(1):78-80. doi:10.1038/sc.2011.100.

Additional Files

Published

2018-04-20