April 11, 2024

(SCIWORA) Spinal Cord Injury Without Radiological Abnormality is the condition where radiological abnormalities are not detected following spinal cord injury mostly in childhood.


It can occur in 2/3rd cases of severe cervical injury in ages less 8 years old who also have the most unfavorable prognosis, which is probably associated with relatively heavy head, weaker neck muscles and greater elasticity of vertebral ligaments in this patient population

Due to inheritance elasticity of the pediatric cervical spine which can allow severe spinal cord injury but with the absence of X-ray findings

SCIWORA occurs as a result of hyperextension forces or from a direct frontal impact to the face in most of cases

Causes of SCIWORA

Transverse atlantal ligamentous injury

Fracture through cartilaginous end-plates (Which are not visualized by X-ray), may be among the causes of injury

Unrecognized inter-ligamentous injury

Adult with acute traumatic disc prolapse

Cervical spondylosis:

  • C-Spinal injury which is due to hyperextension in the already compromised spine
  • Excessive anterior budding of ligamentum flavum into the canal already compromised by posterior vertebral body osteophytes (May cause central cord syndrome)

Diagnosis of SCIWORA

Clinical examination with focus on neurological abnormality should be done

Radiograph is usually performed as diagnosis of exclusion

CT scan will outline the bony pathology

However MRI will outline more anatomical diagnosis and detail injury is investigation of choice

Treatment options

Spine immobilized for at least 12 weeks

Risk activities are avoided for at least 6 months following injury

Devices are removed earlier in stable cases

Post operatively physiotherapy should be done

Reference of above content is taken from mentioned article.