Disclosures: WONJAE JO, MD: No financial relationships or conflicts of interest

Case Description: SCIWORA(Spinal Cord Injury without Radiographic Abnormality) is a term that means objective clinical signs of post-traumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. MRI is known to be useful in diagnosing spinal cord injury in SCIWORA patients as well as for detecting any blood clots, herniated discs or other masses that may be compressing the spinal cord.

Setting: We experienced a patient who was suspected to have traumatic spinal cord injury clinically, but no abnormal findings on MRI.

Patient: A 34-year-old female patient visited our clinic with symptoms of limb weakness, hypoesthesia below C4 dermatome and voiding difficulty after car accident. Assessment/

Results: ASIA impairment scale was D and neurological level of injury was C4. Cervical spine MRI(Magnetic Resonance Imaging), lumbar spine MRI and whole spine T2 saggital MRI showed no abnormal findings except C6-7 central disc protrusion and L4-5 central spinal stenosis. Additional brain MRI was performed, but no abnormal findings were found. The voiding cystourethrography and urodynamic tests were performed due to persistent dysuria of the patient. Hyposensitive, hypotonic, and areflexic bladder findings were confirmed and clean intermittent catheterization was needed to help the patient’s urination.

Discussion: SCIWORA is most commonly seen in children. SCIWORA can also be seen in adults in rare cases. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. However, even if there is no suspicion of spinal cord injury on MRI, it can not completely rule out spinal cord injury.

Conclusion: We concluded that spinal cord injury should not be ruled out by the absence of abnormal findings on the MRI.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/traumatic-spinal-cord-injury-without-abnormal-findings-on-mri/