SCIWORA

CK Cheang
HRPB
Ipoh
 SCIWORA

 S- Spinal

 C- Cord

 I- Injury

 WO- Without

 R- Radiological

 A- Anomalies
 SCIWORA

 First describe by Pang and Wilberger in 1982

 Mainly in the pediatric age group

 Era without MRI

 They describe group of children with clinical spinal cord injury

but xray and CT scan was normal

 10 to 20% of all spinal cord injuries in children

 In elderly small percentage of pt also presented with SCIWORA

 Mechanism of Injury

 Traction

 Direct compression

 Indirect compression

 Vascular injury
 Traction

 In children ligaments are weaker then bone

 Adults are reverse

 The ligaments are elastic

 Able to distract up to 2x length before rupture

 Spinal cord is resistant to traction

 Once traction occurs permanent spinal cord injury occurs

 Compression

 Permanent

 Occult fractures

 Permanent prolapsed disc

 Hematoma
 Compression

 Transient

 Yellow ligament bulging secondary to hyperextension

 Transient subluxation

 Transient disc bulge

 Indirect Compression

 Direct kinetic energy transmitted to the cord

 Cord concussion
 Vascular Injury

 Vascular occlusion

 Dissecting injury of vessels

 Hypotension
 Presentation

 Important to remember

 10% of head injury associated with cervical injury

 Must have high level of suspicions

 Any history of transient neurological deficit related to

cervical injury are SCIWORA until proven otherwise

 Xray or CT scan normal does not means no cervical injury

 Presentation

 Classical presentation

 Transient neurological deficit

 Later minor trauma with severe deficit

 However pt may present with with from transient deficit

to complete neurology

 Diagnosis is difficult

 Your eyes will see what you know

 Investigations

 SCIWORA

 Xray and CT scan essentially normal

 MRI is the only important tools of investigation

 Any pt suspected SCIWORA needs urgent MRI

 Look for either direct or indirect signs on MRI

 Investigation

 Disc space injury

 Inter spinous process hematoma

 Anterior vertebrae space swelling or hematoma

 Bone oedema

 All these you will see in MRI

 If you don’t look for it you won’t see it

 Management

 As any spine injury

 Immobilization

 Surgical decompression for permanent compression

 Support therapy

 Fixation is difficult in children