Sciwora: Diagnosis and treatment A systematic review
Keywords:
SCIWORA, SCIWORETAbstract
SCIWORA (Spinal Cord Injury Without overt Radiological Abnormality) is a term first used by Loyd, back in 1907, even though it became more known in 1982 by Pang. The initial term described a condition were signs of myelopathy were not accompanied by traumatic findings on plain radiographs or on computed tomography and it was mostly believed to be a medical condition seen in children. Throughout the years it has been shown that SCIWORA is not only seen in children but it is also seen in adults. Introducing MRI to the diagnostic algorithm caused controversy about what should be defined as SCIWORA, but it also added to the comprehension of the pathophysiology of SCIWORA. The aim of this study was to investigate the current trends in diagnosis and possible treatments of SCIWORA. The reviewed articles were obtained by using the online Pubmed and Google scholar databases and by following the PRISMA guidelines. While there is no consensus on a protocol, the current management protocols include immediate bracing, avoiding the administration of corticosteroids and performing an MRI as the main diagnostic imaging. The decision for surgical intervention seems to be taken based on the MRI findings and the skills of the practitioner.
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Como, J. J., Samia, H., Nemunaitis, G. A., Jain, V., Anderson, J. S., Malangoni, M. A., & Claridge, J. A. (2012). The misapplication of the term spinal cord injury without radiographic abnormality (SCIWORA) in adults. Journal of Trauma and Acute Care Surgery, 73(5), 1261–1266. https://doi.org/10.1097/ta.0b013e318265cd8c
Zhu, F., Yao, S., Ren, Z., Telemacque, D., Qu, Y., Chen, K., Yang, F., Zeng, L., & Guo, X. (2019). Early durotomy with Duroplasty for severe adult spinal cord injury without radiographic abnormality: A novel concept and method of surgical decompression. European Spine Journal, 28(10), 2275–2282. https://doi.org/10.1007/s00586-019-06091-1
Neva, M. H., Roeder, C. P., Felder, U., Kiener, B., Meier, W., Perler, M., & Heini, P. (2011). Neurological outcome, working capacity and prognostic factors of patients with SCIWORA. Spinal Cord, 50(1), 78–80. https://doi.org/10.1038/sc.2011.100
Dreizin, D., Kim, W., Kim, J. S., Boscak, A. R., Bodanapally, U. K., Munera, F., & Stein, D. M. (2015). Will the real Sciwora Please stand up? exploring clinicoradiologic mismatch in closed spinal cord injuries. American Journal of Roentgenology, 205(4), 853–860. https://doi.org/10.2214/ajr.14.13374
Freigang, V., Butz, K., Seebauer, C. T., Karnosky, J., Lang, S., Alt, V., & Baumann, F. (2021). Management and mid-term outcome after “real sciwora” in children and adolescents. Global Spine Journal, 219256822097913. https://doi.org/10.1177/2192568220979131
Mahajan, P., Jaffe, D. M., Olsen, C. S., Leonard, J. R., Nigrovic, L. E., Rogers, A. J., Kuppermann, N., & Leonard, J. C. (2013). Spinal cord injury without radiologic abnormality in children imaged with magnetic resonance imaging. Journal of Trauma and Acute Care Surgery, 75(5), 843–847. https://doi.org/10.1097/ta.0b013e3182a74abd
Bazán, P. L., Borri, A. E., & Medina, M. (n.d.). Predictors in adult sciwora. Coluna/Columna. Retrieved June 5, 2022, from http://old.scielo.br/scielo.php?pid=S1808-18512013000400014&script=sci_arttext&tlng=en
Basu, S. (2012). Spinal injuries in children. Frontiers in Neurology, 3. https://doi.org/10.3389/fneur.2012.00096
Rolfe, K., Beck, A., Kovach, T., Mayeda, B., & Liu, C. (2019). Non-locality and the misdiagnosis of spinal cord injury without radiographic abnormality: Proof of concept. Spinal Cord Series and Cases, 5(1). https://doi.org/10.1038/s41394-019-0148-1
Jiang, X., Chen, D., Lou, Y., & Li, Z. (2016). Kinematic analysis of cervical spine canal diameter and its association with grade of degeneration. European Spine Journal, 25(7), 2166–2172. https://doi.org/10.1007/s00586-016-4624-z
Boese, C. K., Müller, D., Bröer, R., Eysel, P., Krischek, B., Lehmann, H. C., & Lechler, P. (2016). Spinal Cord Injury without radiographic abnormality (SCIWORA) in adults: MRI type predicts early neurologic outcome. Spinal Cord, 54(10), 878–883. https://doi.org/10.1038/sc.2016.13
Makino, Y., Yokota, H., Hayakawa, M., Yajima, D., Inokuchi, G., Nakatani, E., & Iwase, H. (2014). Spinal cord injuries with normal postmortem CT findings: A pitfall of virtual autopsy for detecting traumatic death. American Journal of Roentgenology, 203(2), 240–244. https://doi.org/10.2214/ajr.13.11775
Knox, J. (2016). Epidemiology of spinal cord injury without radiographic abnormality in children: A nationwide perspective. Journal of Children’s Orthopaedics, 10(3), 255–260. https://doi.org/10.1007/s11832-016-0740-x
Acharya, S., Sharma, V., Sharma, S., & Acharya, J. (n.d.). Evaluation of clinical profile and effect of cervical spinal cord injuries with or without bony injuries: Asian Journal of Medical Research. Retrieved June 5, 2022, from https://aijournals.com/index.php/ajmr/article/view/462
Pang, D., & Wilberger, J. E. (1982). Spinal Cord Injury without radiographic abnormalities in children. Journal of Neurosurgery, 57(1), 114–129. https://doi.org/10.3171/jns.1982.57.1.0114
Liao, C.-C., Lui, T.-N., Chen, L.-R., Chuang, C.-C., & Huang, Y.-C. (2005). Spinal cord injury without radiological abnormality in preschool-aged children: Correlation of magnetic resonance imaging findings with neurological outcomes. Journal of Neurosurgery: Pediatrics, 103(1), 17–23. https://doi.org/10.3171/ped.2005.103.1.0017
R;, K. P. F. B. G. M. K. (n.d.). Injury to the spinal cord without radiological abnormality (SCIWORA) in adults. The Journal of bone and joint surgery. British volume. Retrieved June 5, 2022, from https://pubmed.ncbi.nlm.nih.gov/11041597/
Kriss, V. M., & Kriss, T. C. (1996). Sciwora (spinal cord injury without radiographic abnormality) in infants and children. Clinical Pediatrics, 35(3), 119–124. https://doi.org/10.1177/000992289603500302
Ouchida, J., Yukawa, Y., Ito, K., Katayama, Y., Matsumoto, T., Machino, M., Inoue, T., Tomita, K., & Kato, F. (2016). Delayed magnetic resonance imaging in patients with cervical spinal cord injury without radiographic abnormality. Spine, 41(16). https://doi.org/10.1097/brs.0000000000001505
Shen, H., Tang, Y., Huang, L., Yang, R., Wu, Y., Wang, P., Shi, Y., He, X., Liu, H., & Ye, J. (2006). Applications of diffusion-weighted MRI in thoracic spinal cord injury without radiographic abnormality. International Orthopaedics, 31(3), 375–383. https://doi.org/10.1007/s00264-006-0175-y
Zhang, J.-dong, & Xia, Q. (2015). Role of intraoperative disc contrast injection in determining the segment responsible for cervical spinal cord injury without radiographic abnormalities. Orthopaedic Surgery, 7(3), 239–243. https://doi.org/10.1111/os.12197
Shinozaki, M., Nagoshi, N., Nakamura, M., & Okano, H. (2021). Mechanisms of stem cell therapy in spinal cord injuries. Cells, 10(10), 2676. https://doi.org/10.3390/cells10102676
KZ;, H. S. L. Y. H. W. W. (n.d.). Use of fidji cervical cage in the treatment of cervical spinal cord injury without radiographic abnormality. BioMed research international. Retrieved June 29, 2022, from https://pubmed.ncbi.nlm.nih.gov/23844369/
Qi, C., Xia, H., Miao, D., Wang, X., & Li, Z. (2020). The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA). Journal of Orthopaedic Surgery and Research, 15(1). https://doi.org/10.1186/s13018-020-01743-1
a. Yalcin, N., Dede, O., Alanay, A., & Yazici, M. (2011). Surgical management of post-sciwora spinal deformities in children. Journal of Children’s Orthopaedics, 5(1), 27–33. https://doi.org/10.1007/s11832-010-0306-2
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