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Abstract
Objectives
This study examined the MRI findings, injury mechanism, clinical findings, and prognosis of a spinal cord injury without radiographic abnormality (SCIWORA) in adults with a normal spinal canal.
Summary of Literature
Most reports on SCIWORA deal with the pediatric age group. However, there are few reports on the MRI findings, clinical features and outcomes in adult patients with cervical SCIWORA.
Materials and Methods
The hospital records of 753 patients, who were treated for cervical spine injury between February 1,1994 and July 31, 2004, were reviewed. This study included the 10 subjects with no fractures or dislocation on the plain roentgenograms or cord compression caused by degenerative change or disc herniation on MRI corresponding to the location of the cord lesion. All the patients had at least a 2-year followup evaluation. The relationships between the MRI findings, neurological findings and outcomes were evaluated.
Results
The MRI findings revealed 7 cases with cord contusion, 3 cases with cord edema, 3 cases with gliosis and 3 cases with syrinx formation at the followup. The injury mechanism was hyperextension and hyperflexion in 7 and 3 cases, respectively. The initial motor function scores of ASIA in the edema and contusion groups was 60.7 and 43.9, respectively. At the last followup, the motor function scores of ASIA in the edema and contusion groups were 90 and 70.3, respectively. The Frankel grade improved by 1.3 and 1.1 in the edema and contusion groups, respectively.
Conclusions
In patients with SCIWORA, the MRI findings correlated well with the clinical picture and were of prognostic significance. The cord edema group showed better clinical features than the contusion group, and prognosis was relatively good in both groups. A further careful evaluation, such as MRI, is still needed to determine the appropriate treatment for spinal cord injuries without radiographic abnormalities.
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Figures and Tables%
Fig. 1.
A 54-year-old man (case 2) with acute spinal cord injury. MRI of the cervical cord is obtained after 1 day (A and B) and 12 months (C and D) after injury. (A) Sagittal midline T1-weighted image shows isointensity cord lesion at C3-C4 vertebral level. (B) T2-weighted image shows diffuse hyperintensity cord lesion at C3-C4 level, indicating the existence of edema. (C) Sagittal midline T1-weighted image shows isointensity cord lesion at C3-C4 level. (D) T2-weighted image shows ill defined diffuse hyperintensity cord lesion at C3-C4 level, indicating gliosis.
Fig. 2.
A 52-year-old man (case 4) presenting Frankel C. MRI of the cervical spine was obtained 2 days (A and B) and 12 months (C, D and E) after injury. (A) Sagittal T1- weighted image shows slightly hypointensity cord lesion at C1-C2 level. (B) T2-weighted image shows relatively well defined hyperintensity cord lesion at C1-C2 level, indicating existence of cord contusion. (C) Sagittal midline T1-weighted image shows well defined decreased sized hypointensity cord lesion at C1-C2 level. (D) T2-weighted image shows well defined hyperintensity cord lesion at C1-C2 level. (E) T1-weighted Gadullium enhanced image shows well defined decreased sized hypointensity (not enhanced) cord lesion at C1-C2 level, indicating post-traumatic syrinx.
Fig. 3.
34-year-old woman (case 6) presenting Frankel B, MRI was performed 1day (A and B) and 6 weeks (C and D) after injury. (A) Sagittal midline T1-weighted image showing isointensity swollen cord lesion at C3-C5 level. (B) T2-weighted image showing relatively diffuse heterogenous intensity cord lesion at C3-C5 level, indicating diffuse spinal cord contusion and swelling. Post-laminoplasty state; (C) Sagittal midline T1-weighted image showing slightly hypointensity cord lesion at C4-C5 level. (D) T2-weighted image showing well defined hyperintensity cord lesion at C4-C5 level, indicating post-traumatic syrinx.
Table 1.
Clinical summary of patients with SCIWORA
| Case No. | Age | Sex | Cause of injury | Level of injury | MRI finding (days)* | Follow up MRI |
|---|---|---|---|---|---|---|
| 01. | 70 | M | direct blow on neck | C1-2 | contusion (2) | syrinx |
| 02. | 54 | M | fall from height | C3-4 | edema (1) | gliosis |
| 03. | 41 | M | bicycle accident | C3-4 | edema (2) | |
| 04. | 52 | M | pedestrian injury | C1-2 | contusion (1) | syrinx |
| 05. | 28 | M | slipped down | C1-2 | contusion (2) | |
| 06. | 34 | F | bicycle accident | C2-5 | contusion/swelling (1) | syrinx |
| 07. | 69 | F | fall from height | C3-5 | contusion (7) | |
| 08. | 44 | M | motorcycle accident | C3-4 | contusion (2) | gliosis |
| 09. | 47 | M | car accident | C2-4 | contusion (2) | gliosis |
| 10. | 33 | M | fall from height | C3-4 | edema (5) |
Table 2.
Neurologic change after treatment
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