Cervical spinal cord injury with and without the radiographical evidence of trauma - A retrospective comparative study in adults

Background: Spinal cord injury without the radiographical evidence of trauma (SCIWORET) is a well described entity in children. This phenomenon is not well described in the adult population. There has been no study till date that compares the prognosis of SCIWORET in adults to those with bony injury. Aims: To compare the clinical and magnetic resonance imaging (MRI) findings of cervical spinal cord injury (SCI) with the conventional radiographical evidence of trauma to those with cervical SCI, without the conventional radiographical evidence of trauma (SCIWORET) and to study the importance of MRI and the prevalence of SCIWORET in adult cervical spine trauma. Settings and Design:A retrospective study on patients who presented to the Department of Radiodiagnosis and Imaging with acute cervical spine trauma over a period of 5 years (between August 2002 and September 2007). Methods: 50 patients with acute cervical SCI were divided into two groups. Group A included those without radiographical abnormality and Group B included those with bony injury. The epidemiological factors, the total motor scores on admission as well as on follow up, the recovery rate, the average extent of spinal cord oedema and the prevalence of ligamentous injury were compared in both groups. Results: SCIWORET was associated with better motor scores and recovery rate when compared with SCI which is associated with bony injury. Ligamentous injuries were significantly more commonly associated with bony injury. Conclusion: Cervical SCIWORET is not an uncommon phenomenon in adults. The overall outlook is better when compared to cervical spine trauma which is associated with bony injury, as SCIWORET is associated with better motor function and a lesser incidence of ligamentous injury.