Spinal cord injury without radiographic abnormality in adults

Spinal cord injury without fractures or bony malalignment on either plain r adiographs or computed tomography (SCIWORA) is most commonly found in the p aediatric age group. In recent years, magnetic resonance imaging (MRI) has been used to evaluate these patients. The present communication describes S CIWORA in 15 adult patients investigated by MRI. Of the 151 patients with s pinal cord injury in 1 year, 15 adult patients had cervical SCIWORA. All pa tients were evaluated by MRI. The age ranged from 20-60 years. Eleven patie nts had partial cord injury, two had a complete cord syndrome while two had a central cord syndrome. MRI demonstrated an intervertebral disc prolapse in six patients, intramedullary haematoma/contusion in four and cord oedema in four patients. One patient had multiple disc prolapses and associated i ntramedullary haematoma. Patients with disc prolapse were operated upon and all showed neurological improvement. The rest of the patients were managed conservatively. There was mild improvement in patients with intramedullary haematomas while those with cord oedema alone showed moderate recovery. Th e pathogenesis of adult SCIWORA is possibly different from that in paediatr ic age group. Most of the patients with SCIWORA show some abnormality on MR imaging. MRI should therefore be done in all patients with spinal cord inj ury for diagnostic and prognostic purposes.