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Advances in Orthopedics
Volume 2018, Article ID 7060654, 10 pages
https://doi.org/10.1155/2018/7060654
Review Article

Posttraumatic Spinal Cord Injury without Radiographic Abnormality

1Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
2Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
3Royal Victoria Hospital and Royal Belfast Hospital for Sick Children, Belfast, UK
4Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
5Department of Pediatric Neurosurgery, University of California, Davis, CA, USA
6Regional Centre for Paediatric Neurosurgery, Kaiser Permanente Hospitals, Oakland, CA, USA
7Great Ormond Street Hospital For Children, NHS Trust, London, UK

Correspondence should be addressed to Kivanc Atesok; ude.cmbau@kosetaK

Received 22 August 2017; Revised 2 December 2017; Accepted 7 December 2017; Published 4 January 2018

Academic Editor: John P. Kostuik

Copyright © 2018 Kivanc Atesok et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

“Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.