Spinal cord injury without radiological abnormality (SCIWORA) in a young female and pharmacological treatment option: a case report with review of literature

Sanja Sakan, Daniela Bandic Pavlovic, Robert Baronica, Iva Rukavina, Ranka Stern-Padovan, Ivan Dobric


Acute spinal cord injury strikes labour active young and middle-aged population, especially men, and consequently usually results in difficult neurological sequel. Also disables normal quality of life and everyday functioning in these patients despite many available supportive measures. Spinal cord injury without radiological abnormality (SCIWORA) presents a great diagnostic challenge because radiological and computed tomography pictures are without visible pathology which would explain the new onset of the neurological deficit. For the first time we report a true spinal cord injury without radiological abnormality in the X-ray, computed tomography and magnetic resonance imaging in a young female manifested with moderate neurological deficit after the traffic accident. Although SCIWORA is very rare in adults, high level of suspicion in emergency department is advisable as the timely applied neuroprotective measures can prevent the onset of the neurological deficit. It is important to emphasize that emergency magnetic resonance imaging application is the diagnostic key. Albeit, the SCIWORA neurologic deficit can show up with a delay of four days after the spinal cord injury in a patient with a normal physical and radiological examination. Treatment of these patients is another challenge for every physician. In fact pharmacological treatment options are still in the experimental research phase. We can conclude that currently the neuroprotective measures of the acute spinal cord injury patient started in the emergency department regardless the radiological test findings represent the right and successful key treatment.



Corticosteroids, SCIWORA, Spinal cord injury, MRI

Full Text:



Kalra V, Gulati S, Kamate M, Garg A. SCIWORA-Spinal cord injury without radiological abnormality. Indian J Pediatr 2006;73:829-31.

Sharma S, Manjeet S, Iftikhar HW et al. Adult spinal cord injury without radiographic abnormalities (SCIWORA): clinical and radiological correlations. J Clin Med Res 2009;1: 165-172. Doi:10.402/jocmr2009.08.1256.

Dare AO, Dias MS, Li V. Magnetic resonance imaging correlation in pediatric spinal cord injury withoutradiographic abnormality. J Neurosurg 2002;97 (1 Suppl):33-9.

Grabb PA, Pang D. Magnetic resonance imaging in the evaluation of spinal cord injury without radiographic abnormality in children. Neurosurgery 1994;35:406-14.

Pang D, Pollack IF. Spinal cord injury without radiographic abnormalityin children: the SCIWORA syndrome. J Trauma 1989;29:654-64.

Pang D, Wilberger JE Jr. Spinal cord injury without radiographicabnormalities in children. J Neurosurg 1982;57:114-29.

Gupta SK, Rajeev K, Khosla VK et al. Spinal cord injury without radiographic abnormality in adults. Spinal Cord 1999;37:726-9.

Launay F, Leet AI, Sponseller PD. Pediatric spinal cord injury withoutradiographic abnormality: a meta- analysis. Clin Orthop Relat Res2005;433:166-70.

Saruhashi Y, Hukuda S, Katsuura A, Asajima S, Omura K. Clinical outcomes of cervical spinal cord injuries without radiographic evidence of trauma. Spinal Cord 1998;36:567-73.

Tator CH. Spine-spinal cord relationships in spinal cord trauma. Clin Neurosurg 1983;30:479-94.

Como JJ, Samia H, Nemunaitis GA et al. The misapplication of the term spinal cord injury without radiographic abnormality (SCIWORA) in adults. J Trauma Acute Care Surg 2012;73:1261-6. Doi:10.1097/TA.0b013e318265cd8c.

Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev 2012;18:1: CD001046.doi:10.1002/14651858.CD001046.pub2.

Osenbach RK, Menezes AH. Pediatric spinal cord and vertebral column injury. Neurosurgery 1992;30: 385-90.

Pharmacological Management of Acute Spinal Cord Injury- Alok Sharma 2012-Suppl To Japi

Hon KE, Chan SS, BK Ng, WC Chu. Spinal cord injury without radiographic abnormality (SCIWORA): A mere 50-cm fall that matters. Injury Extra 2006;37:364-70.

Park MC, Bok SK, Lee SJ, Ahn DH, Lee YJ. Delayed onset of thoracic SCIWORA in adults. Ann Rehabil Med 2012;36:871-5. Doi:10.5535/arm.2012.36.6.871.

Hurlbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg 2000;93 (1 Suppl):1-7.

Rozzelle CJ, Arabi B, Dhall S et al. Spinal cord injury without radiographic abnormality (SCIWORA). Neurosurgery 2013;72:227-233. Doi:10.1227/NEU. 0b013e3182770ebc.

Hurlbert RJ, Hadley MN, Walters BC et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery 2013;72:93-105. Doi:10.1227/NEU.0b013e31827765c6.

Wing PC, Nance P, Connell DG et al. Risk of avascular necrosis following short term megadose methylprednisolone treatment. Spinal Cord 1998;36:633-6.

Hall ED. Inhibition of lipid peroxidation in central nervous system trauma and ischemia. J Neurol Sci 1995;134 Suppl:79-83.

Hall ED. Efficacy and mechanisms of action of the cytoprotective lipid peroxidation inhibitor tirilazad mesylate in subarachnoid haemorrhage. Eur J Anaesthesiol 1996;13:279-89.

Geisler FH, Coleman WP, Grieco G et al. The Sygen multicenter acute spinal cord injury study. Spine 2001;26 (24 Suppl):87-98.

Faden AL, Jacobs TP, Mougey E, Holday JN. Endorphins in experimental spinal injury: therapeutic effect of naloxone. Ann Neurol 1981;10: 326-32.

Hadley MN, Walters BC. Introduction of the guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery 2013; 72:5-16. Doi:10.1227/NEU.0b013e3182773549.

Tewari MK, Gifti DS, Singh P et al. Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging: analysis of 40 patients. Surg Neurol 2005;63:204-9.

Delialioglu SU, Culha C, Yigit Z, Ozel S, Dlialioglu O. Cervicothoracic spinal cord injury without radiographic evidence of trauma (SCIWORET) in an adult: a case report. Turk J Phys Med Rehab 2007;53:164-7.

Grabb PA, Albright AL. Spinal cord injury without radiographic abnormality in childre. In: Wilkins RH and Rengachary SS (eds). Neurosurgery, 2nd edn, McGraw Hill, New York, 1996: pp2867-2870.

Kraus JF. Epidemiological features of head and spinal cord injury. In: Schoenberg S (ed). Neurological Epidemiology: Principles and Clinical Application. Advances in Neurology, Vol 19, New York, Raven Press, 1978: pp 261-279.

Ungoren K, Secer HI, Solmaz I, Akay KM. Spinal cord injury without radiographic abnormality (SCIWORA) in a young man: case report. J Nervous Sys Surgery 2009;2:21-6.

Kasimatis GB, Panagiotopoulos E, Megas P et al. The adult spinal cord injury without radiographic abnormalities syndrome: magnetic resonance imaging and clinical findings in adults with spinal cord injuries having normal radiographs and computed tomography studies. J Trauma 2008; 65:86-93. Doi:10.1097/TA.0b013e318157495a.

Hardy AG. Cervical spinal cord injury without bony injury. Paraplegia 1997;14:296-305.

Frankel HL, Hancock DO, Hyslop G et al. The value of postual reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 1969;7:179-192.

Dickman CA, Zabramski JM, Hadley MN, Rekate HL, Sonntag VK.Pediatric spinal cord injury without radiographic abnormalities:report of 26 cases and review of the literature. J Spinal Disord 1991;4:296-305.

Harrigan MR, Hadley MN, Dhall S et al. Management of vertebral artrey injuries following non-penetrating cervical trauma. Neurosurgery 2013;72:234-243. Doi:10.1227/NEU.0b013e31827765f5.

Kothari P, Freeman B, Grevitt M, Kerslake R. Injury to the spinal cord without radiological abnormality (SCIWORA) in adults. J Bone Joint Surg Br 2000;82:1034-7.