Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging: analysis of 40 patients

• Published in: Surgical neurology Vol. 63; no. 3; pp. 204 - 209
• Main Authors: Tewari, Manof K., Gifti, Difender S., Singh, Paramjit, Khosla, Virender K., Mathuriya, Suresh N., Gupta, Sunil K., Pathak, Ashis
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2005
• Subjects: Adolescent; Adult; Age Distribution; Aged; Disease Progression; Edema - diagnosis; Edema - epidemiology; Female; Humans; Incidence; India - epidemiology; Magnetic resonance imaging (MRI); Magnetic Resonance Imaging - statistics & numerical data; Male; Methylprednisolone - therapeutic use; Middle Aged; Predictive Value of Tests; Prognosis; Radiography; Sex Distribution; Spinal Cord - diagnostic imaging; Spinal Cord - pathology; Spinal Cord - physiopathology; Spinal Cord Injuries - diagnosis; Spinal Cord Injuries - epidemiology; Spinal cord injury (SCI); Spinal cord injury without radiographic abnormality (SCIWORA); Spinal cord injury without radiological evidence of trauma (SCIWORET); Spinal cord injury (SCI); Magnetic resonance imaging (MRI); Prognosis; Spinal cord injury without radiographic abnormality (SCIWORA); Spinal cord injury without radiological evidence of trauma (SCIWORET)
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2004.05.042

Spinal cord injury without radiographic abnormality (SCIWORA) is not uncommon among middle-aged and elderly people. It is less reported in adults as compared with children. This study was undertaken to find the incidence, magnetic resonance imaging (MRI) changes, and outcome of SCIWORA in adults and to demonstrate the prognostic value of MRI in SCIWORA. Forty adult patients who sustained SCIWORA for a period of 2 years (January 1999 to December 2000) were admitted to our hospital. Methylprednisolone was given in therapeutic doses, for a period of 24 hours, to those arriving within 6 hours of injury. Magnetic resonance imaging was performed within 72 hours of admission to the hospital. In all patients, sagittal, axial, and coronal T1, spin, and T2 images of MRI were obtained. Clinical status of the patient at the time of admission and discharge was correlated with MRI. Four patients (10%), who were in Frankel grade D, with no demonstrable injury on MRI, improved to Frankel grade E at the time of discharge. Two patients (5%) with cord edema and extraneural injury improved to a useful neurological grade (Frankel grades D or E), whereas 13 patients (32.5%) with MRI features of cord contusion and hemorrhage did not achieve useful neurological function. Spinal cord injury without radiographic abnormality contributes 12% of cases of spinal cord injury. Magnetic resonance imaging is the investigation of choice, having diagnostic and prognostic value because it demonstrates neural and extraneural injuries and helps to pick up surgically correctable abnormality. Patients with minimal cord changes on MRI have the best outcome followed by those with cord edema. Patients with parenchymatous hemorrhage and contusion on MRI fare badly.