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SCIWORA
Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Spinal cord injury without radiological abnormality (SCIWORA), spinal cord injury (SCI)
              • Definitions

                • Pre-MR term (Pang and Wilberger, 1982)
                  • 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

                                        1. Khatri K et al: Spinal cord injury without radiological abnormality in adult thoracic spinal trauma. Arch Trauma Res. 3(3):e19036, 2014
                                        2. 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
                                        3. 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
                                        4. 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
                                        5. 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
                                        6. Phillips BC et al: Spinal cord avulsion in the pediatric population: case study and review. Pediatr Emerg Care. 29(10):1111-3, 2013
                                        7. Rozzelle CJ et al: Spinal cord injury without radiographic abnormality (SCIWORA). Neurosurgery. 72 Suppl 2:227-33, 2013
                                        8. 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
                                        9. Piatt JH Jr et al: Spinal cord injury without radiographic abnormality and the Chiari malformation: controlled observations. Pediatr Neurosurg. 48(6):360-3, 2012
                                        10. 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
                                        11. 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
                                        12. 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
                                        13. Yucesoy K et al: SCIWORA in MRI era. Clin Neurol Neurosurg. 110(5):429-33, 2008
                                        14. Robles LA: Traumatic spinal cord infarction in a child: case report and review of literature. Surg Neurol. 67(5):529-34, 2007
                                        15. Betz RR et al: Acute evaluation and management of pediatric spinal cord injury. J Spinal Cord Med. 27 Suppl 1:S11-5, 2004
                                        16. Carreon LY et al: Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech. 17(6):477-82, 2004
                                        17. Cirak B et al: Spinal injuries in children. J Pediatr Surg. 39(4):607-12, 2004
                                        18. Pang D: Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 55(6):1325-42; discussion 1342-3, 2004
                                        19. 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
                                        20. Izma MK et al: Spinal cord injury without radiological abnormality (SCIWORA). Med J Malaysia. 58(1):105-10, 2003
                                        21. 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
                                        22. 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
                                        23. Koestner AJ et al: Spinal cord injury without radiographic abnormality (SCIWORA) in children. J Trauma Nurs. 8(4):101-8, 2001
                                        24. 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
                                        25. Baker C et al: Evaluation of pediatric cervical spine injuries. Am J Emerg Med. 17(3):230-4, 1999
                                        26. Graber MA et al: Cervical spine radiographs in the trauma patient. Am Fam Physician. 59(2):331-42, 1999
                                        27. Pollina J et al: Tandem spinal cord injuries without radiographic abnormalities in a young child. Pediatr Neurosurg. 30(5):263-6, 1999
                                        28. Marinier M et al: Spinal cord injury without radiographic abnormality (SCIWORA). Orthop Nurs. 16(5):57-63; quiz 64-5, 1997
                                        29. Kriss VM et al: SCIWORA (spinal cord injury without radiographic abnormality) in infants and children. Clin Pediatr (Phila). 35(3):119-24, 1996
                                        30. 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
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Spinal cord injury without radiological abnormality (SCIWORA), spinal cord injury (SCI)
                                                    • Definitions

                                                      • Pre-MR term (Pang and Wilberger, 1982)
                                                        • 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

                                                                              1. Khatri K et al: Spinal cord injury without radiological abnormality in adult thoracic spinal trauma. Arch Trauma Res. 3(3):e19036, 2014
                                                                              2. 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
                                                                              3. 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
                                                                              4. 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
                                                                              5. 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
                                                                              6. Phillips BC et al: Spinal cord avulsion in the pediatric population: case study and review. Pediatr Emerg Care. 29(10):1111-3, 2013
                                                                              7. Rozzelle CJ et al: Spinal cord injury without radiographic abnormality (SCIWORA). Neurosurgery. 72 Suppl 2:227-33, 2013
                                                                              8. 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
                                                                              9. Piatt JH Jr et al: Spinal cord injury without radiographic abnormality and the Chiari malformation: controlled observations. Pediatr Neurosurg. 48(6):360-3, 2012
                                                                              10. 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
                                                                              11. 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
                                                                              12. 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
                                                                              13. Yucesoy K et al: SCIWORA in MRI era. Clin Neurol Neurosurg. 110(5):429-33, 2008
                                                                              14. Robles LA: Traumatic spinal cord infarction in a child: case report and review of literature. Surg Neurol. 67(5):529-34, 2007
                                                                              15. Betz RR et al: Acute evaluation and management of pediatric spinal cord injury. J Spinal Cord Med. 27 Suppl 1:S11-5, 2004
                                                                              16. Carreon LY et al: Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech. 17(6):477-82, 2004
                                                                              17. Cirak B et al: Spinal injuries in children. J Pediatr Surg. 39(4):607-12, 2004
                                                                              18. Pang D: Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 55(6):1325-42; discussion 1342-3, 2004
                                                                              19. 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
                                                                              20. Izma MK et al: Spinal cord injury without radiological abnormality (SCIWORA). Med J Malaysia. 58(1):105-10, 2003
                                                                              21. 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
                                                                              22. 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
                                                                              23. Koestner AJ et al: Spinal cord injury without radiographic abnormality (SCIWORA) in children. J Trauma Nurs. 8(4):101-8, 2001
                                                                              24. 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
                                                                              25. Baker C et al: Evaluation of pediatric cervical spine injuries. Am J Emerg Med. 17(3):230-4, 1999
                                                                              26. Graber MA et al: Cervical spine radiographs in the trauma patient. Am Fam Physician. 59(2):331-42, 1999
                                                                              27. Pollina J et al: Tandem spinal cord injuries without radiographic abnormalities in a young child. Pediatr Neurosurg. 30(5):263-6, 1999
                                                                              28. Marinier M et al: Spinal cord injury without radiographic abnormality (SCIWORA). Orthop Nurs. 16(5):57-63; quiz 64-5, 1997
                                                                              29. Kriss VM et al: SCIWORA (spinal cord injury without radiographic abnormality) in infants and children. Clin Pediatr (Phila). 35(3):119-24, 1996
                                                                              30. 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