Objective traumatic SCI without ligamentous injury or fracture detectable on radiographs
Original definition excludes penetrating trauma, electrical shock, obstetric complications, and congenital spine anomalies
Term SCIWORA is antiquated in MR era
Intervertebral disc herniation, spinal epidural hematoma, spinal cord contusion, and hematomyelia may be occult on CT and radiographs but obvious on MR
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Bonfanti L et al: Adult spinal cord injury without radiographic abnormality (sciwora). Two case reports and a narrative review. Acta Biomed. 89(4):593-8, 2019
Asan Z: Spinal cord injury without radiological abnormality in adults: clinical and radiological discordance. World Neurosurg. 114:e1147-51, 2018
Atesok K et al: Posttraumatic spinal cord injury without radiographic abnormality. Adv Orthop. 2018:7060654, 2018
Boese CK et al: Spinal cord injury without radiographic abnormality (SCIWORA) in adults: MRI type predicts early neurologic outcome. Spinal Cord. 54(10):878-83, 2016
Khatri K et al: Spinal cord injury without radiological abnormality in adult thoracic spinal trauma. Arch Trauma Res. 3(3):e19036, 2014
Makino Y et al: Spinal cord injuries with normal postmortem CT findings: a pitfall of virtual autopsy for detecting traumatic death. AJR Am J Roentgenol. 203(2):240-4, 2014
Boese CK et al: Early magnetic resonance imaging in spinal cord injury without radiological abnormality in adults: a retrospective study. J Trauma Acute Care Surg. 74(3):845-8, 2013
Boese CK et al: Spinal cord injury without radiologic abnormalities in adults: a systematic review. J Trauma Acute Care Surg. 75(2):320-30, 2013
Mahajan P et al: Spinal cord injury without radiologic abnormality in children imaged with magnetic resonance imaging. J Trauma Acute Care Surg. 75(5):843-7, 2013
Phillips BC et al: Spinal cord avulsion in the pediatric population: case study and review. Pediatr Emerg Care. 29(10):1111-3, 2013
Rozzelle CJ et al: Spinal cord injury without radiographic abnormality (SCIWORA). Neurosurgery. 72 Suppl 2:227-33, 2013
Como JJ et al: The misapplication of the term spinal cord injury without radiographic abnormality (SCIWORA) in adults. J Trauma Acute Care Surg. 73(5):1261-6, 2012
Piatt JH Jr et al: Spinal cord injury without radiographic abnormality and the Chiari malformation: controlled observations. Pediatr Neurosurg. 48(6):360-3, 2012
Schottler J et al: Spinal cord injuries in young children: a review of children injured at 5 years of age and younger. Dev Med Child Neurol. 54(12):1138-43, 2012
Kasimatis GB et al: The adult spinal cord injury without radiographic abnormalities syndrome: magnetic resonance imaging and clinical findings in adults with spinal cord injuries having normal radiographs and computed tomography studies. J Trauma. 65(1):86-93, 2008
Polk-Williams A et al: Cervical spine injury in young children: a National Trauma Data Bank review. J Pediatr Surg. 43(9):1718-21, 2008
Yucesoy K et al: SCIWORA in MRI era. Clin Neurol Neurosurg. 110(5):429-33, 2008
Robles LA: Traumatic spinal cord infarction in a child: case report and review of literature. Surg Neurol. 67(5):529-34, 2007
Betz RR et al: Acute evaluation and management of pediatric spinal cord injury. J Spinal Cord Med. 27 Suppl 1:S11-5, 2004
Carreon LY et al: Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech. 17(6):477-82, 2004
Cirak B et al: Spinal injuries in children. J Pediatr Surg. 39(4):607-12, 2004
Pang D: Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 55(6):1325-42; discussion 1342-3, 2004
Ergun A et al: Pediatric care report of spinal cord injury without radiographic abnormality (SCIWORA): case report and literature review. Spinal Cord. 41(4):249-53, 2003
Izma MK et al: Spinal cord injury without radiological abnormality (SCIWORA). Med J Malaysia. 58(1):105-10, 2003
Bosch PP et al: Pediatric spinal cord injury without radiographic abnormality (SCIWORA): the absence of occult instability and lack of indication for bracing. Spine (Phila Pa 1976). 27(24):2788-800, 2002
Brown RL et al: Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg. 36(8):1107-14, 2001
Koestner AJ et al: Spinal cord injury without radiographic abnormality (SCIWORA) in children. J Trauma Nurs. 8(4):101-8, 2001
Kothari P et al: Injury to the spinal cord without radiological abnormality (SCIWORA) in adults. J Bone Joint Surg Br. 82(7):1034-7, 2000
Baker C et al: Evaluation of pediatric cervical spine injuries. Am J Emerg Med. 17(3):230-4, 1999
Graber MA et al: Cervical spine radiographs in the trauma patient. Am Fam Physician. 59(2):331-42, 1999
Pollina J et al: Tandem spinal cord injuries without radiographic abnormalities in a young child. Pediatr Neurosurg. 30(5):263-6, 1999
Marinier M et al: Spinal cord injury without radiographic abnormality (SCIWORA). Orthop Nurs. 16(5):57-63; quiz 64-5, 1997
Kriss VM et al: SCIWORA (spinal cord injury without radiographic abnormality) in infants and children. Clin Pediatr (Phila). 35(3):119-24, 1996
Turgut M et al: Spinal injuries in the pediatric age group: a review of 82 cases of spinal cord and vertebral column injuries. Eur Spine J. 5(3):148-52, 1996
Objective traumatic SCI without ligamentous injury or fracture detectable on radiographs
Original definition excludes penetrating trauma, electrical shock, obstetric complications, and congenital spine anomalies
Term SCIWORA is antiquated in MR era
Intervertebral disc herniation, spinal epidural hematoma, spinal cord contusion, and hematomyelia may be occult on CT and radiographs but obvious on MR
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Bonfanti L et al: Adult spinal cord injury without radiographic abnormality (sciwora). Two case reports and a narrative review. Acta Biomed. 89(4):593-8, 2019
Asan Z: Spinal cord injury without radiological abnormality in adults: clinical and radiological discordance. World Neurosurg. 114:e1147-51, 2018
Atesok K et al: Posttraumatic spinal cord injury without radiographic abnormality. Adv Orthop. 2018:7060654, 2018
Boese CK et al: Spinal cord injury without radiographic abnormality (SCIWORA) in adults: MRI type predicts early neurologic outcome. Spinal Cord. 54(10):878-83, 2016
Khatri K et al: Spinal cord injury without radiological abnormality in adult thoracic spinal trauma. Arch Trauma Res. 3(3):e19036, 2014
Makino Y et al: Spinal cord injuries with normal postmortem CT findings: a pitfall of virtual autopsy for detecting traumatic death. AJR Am J Roentgenol. 203(2):240-4, 2014
Boese CK et al: Early magnetic resonance imaging in spinal cord injury without radiological abnormality in adults: a retrospective study. J Trauma Acute Care Surg. 74(3):845-8, 2013
Boese CK et al: Spinal cord injury without radiologic abnormalities in adults: a systematic review. J Trauma Acute Care Surg. 75(2):320-30, 2013
Mahajan P et al: Spinal cord injury without radiologic abnormality in children imaged with magnetic resonance imaging. J Trauma Acute Care Surg. 75(5):843-7, 2013
Phillips BC et al: Spinal cord avulsion in the pediatric population: case study and review. Pediatr Emerg Care. 29(10):1111-3, 2013
Rozzelle CJ et al: Spinal cord injury without radiographic abnormality (SCIWORA). Neurosurgery. 72 Suppl 2:227-33, 2013
Como JJ et al: The misapplication of the term spinal cord injury without radiographic abnormality (SCIWORA) in adults. J Trauma Acute Care Surg. 73(5):1261-6, 2012
Piatt JH Jr et al: Spinal cord injury without radiographic abnormality and the Chiari malformation: controlled observations. Pediatr Neurosurg. 48(6):360-3, 2012
Schottler J et al: Spinal cord injuries in young children: a review of children injured at 5 years of age and younger. Dev Med Child Neurol. 54(12):1138-43, 2012
Kasimatis GB et al: The adult spinal cord injury without radiographic abnormalities syndrome: magnetic resonance imaging and clinical findings in adults with spinal cord injuries having normal radiographs and computed tomography studies. J Trauma. 65(1):86-93, 2008
Polk-Williams A et al: Cervical spine injury in young children: a National Trauma Data Bank review. J Pediatr Surg. 43(9):1718-21, 2008
Yucesoy K et al: SCIWORA in MRI era. Clin Neurol Neurosurg. 110(5):429-33, 2008
Robles LA: Traumatic spinal cord infarction in a child: case report and review of literature. Surg Neurol. 67(5):529-34, 2007
Betz RR et al: Acute evaluation and management of pediatric spinal cord injury. J Spinal Cord Med. 27 Suppl 1:S11-5, 2004
Carreon LY et al: Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech. 17(6):477-82, 2004
Cirak B et al: Spinal injuries in children. J Pediatr Surg. 39(4):607-12, 2004
Pang D: Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 55(6):1325-42; discussion 1342-3, 2004
Ergun A et al: Pediatric care report of spinal cord injury without radiographic abnormality (SCIWORA): case report and literature review. Spinal Cord. 41(4):249-53, 2003
Izma MK et al: Spinal cord injury without radiological abnormality (SCIWORA). Med J Malaysia. 58(1):105-10, 2003
Bosch PP et al: Pediatric spinal cord injury without radiographic abnormality (SCIWORA): the absence of occult instability and lack of indication for bracing. Spine (Phila Pa 1976). 27(24):2788-800, 2002
Brown RL et al: Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg. 36(8):1107-14, 2001
Koestner AJ et al: Spinal cord injury without radiographic abnormality (SCIWORA) in children. J Trauma Nurs. 8(4):101-8, 2001
Kothari P et al: Injury to the spinal cord without radiological abnormality (SCIWORA) in adults. J Bone Joint Surg Br. 82(7):1034-7, 2000
Baker C et al: Evaluation of pediatric cervical spine injuries. Am J Emerg Med. 17(3):230-4, 1999
Graber MA et al: Cervical spine radiographs in the trauma patient. Am Fam Physician. 59(2):331-42, 1999
Pollina J et al: Tandem spinal cord injuries without radiographic abnormalities in a young child. Pediatr Neurosurg. 30(5):263-6, 1999
Marinier M et al: Spinal cord injury without radiographic abnormality (SCIWORA). Orthop Nurs. 16(5):57-63; quiz 64-5, 1997
Kriss VM et al: SCIWORA (spinal cord injury without radiographic abnormality) in infants and children. Clin Pediatr (Phila). 35(3):119-24, 1996
Turgut M et al: Spinal injuries in the pediatric age group: a review of 82 cases of spinal cord and vertebral column injuries. Eur Spine J. 5(3):148-52, 1996
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