Posttraumatic Spinal Cord Injury without Radiographic Abnormality

Figure 4

SCIWORA Algorithm. Pure intraneural MRI findings including edema or hemorrhage within the cord parenchyma is not an indication for surgery. Pure extraneural injury including severely injured ligaments or compression even without findings within the cord may be an indication for surgery. Patients with mixed extraintraneural MRI findings have the highest chance to require surgical treatment. Please note that there could be variations in diagnostic work up and treatment based on institutional or surgeons’ preferences. Main indications for surgical treatment are cord compression and ligamentous instability along with worsening or not-improving neurological findings. (Courtesy of University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, USA.)