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成人无放射学异常的脊髓损伤（SCIWORA）：临床与放射学相关性

Adult Spinal Cord Injury without Radiographic Abnormalities (SCIWORA): Clinical and Radiological Correlations.

作者信息

Sharma Siddhartha, Singh Manjeet, Wani Iftikhar H, Sharma Sushil, Sharma Narendra, Singh Dara

机构信息

Postgraduate Department of Orthopedics, Government Medical College, Jammu, India.

出版信息

J Clin Med Res. 2009 Aug;1(3):165-72. doi: 10.4021/jocmr2009.08.1256. Epub 2009 Aug 20.

DOI:10.4021/jocmr2009.08.1256
PMID:22493651
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3318880/
Abstract

BACKGROUND

This study is aimed to determine the clinical and radiological corellations of adult patients with Spinal Cord Injury Without Radiographic Abnormalities (SCIWORA).

METHODS

The study population consisted of all adult patients with suspected cervical spine injury. SCIWORA was defined as the presence of either no injury or a neural injury on Magnetic Resonance Imaging (MRI) in the absence of radiographic or Computed Tomographic (CT) Scan findings suggestive of trauma in patients with neurological deficit. Purely extra neural compressive lesions were excluded from the study.

RESULTS

Twelve of ninety seven (12.4%) patients had a neural injury on MRI with normal radiographs and CT scan. These included cord contusion in five cases, cord edema in five cases and cord hemorrhage in two cases. Ten patients were managed conservatively and two patients with disc prolapse were managed surgically. All patients showed at least one ASIA Impairment Scale (AIS) grade improvement and three patients (25%) recovered completely.

CONCLUSIONS

Parenchymal spinal cord injury is the single most important determinant in the long term outcome of adult SCIWORA patients. Cord hemorrhage has the worst prognosis and cord edema has the best. Longitudinal signal extension and associated extra neural injuries are also associated with poorer outcomes. Cases with purely neural injuries can be managed conservatively, but associated extra neural injuries, especially disc prolapse and ligamentous instability, warrant surgical management.

KEYWORDS

Post Traumatic Myelopathy; Spinal Cord Trauma; Computed tomography; Magnetic resonance imaging; SCIWORA.

摘要

背景

本研究旨在确定无放射学异常的脊髓损伤（SCIWORA）成年患者的临床和影像学相关性。

方法

研究人群包括所有疑似颈椎损伤的成年患者。SCIWORA定义为在存在神经功能缺损的患者中，磁共振成像（MRI）显示无损伤或有神经损伤，而X线片或计算机断层扫描（CT）扫描未发现提示创伤的表现。单纯的神经外压迫性病变被排除在研究之外。

结果

97例患者中有12例（12.4%）MRI显示有神经损伤，而X线片和CT扫描正常。其中包括5例脊髓挫伤、5例脊髓水肿和2例脊髓出血。10例患者采用保守治疗，2例椎间盘突出患者采用手术治疗。所有患者的美国脊髓损伤协会（ASIA）损伤分级至少提高了一级，3例患者（25%）完全康复。

结论

脊髓实质损伤是成年SCIWORA患者长期预后的最重要单一决定因素。脊髓出血预后最差，脊髓水肿预后最好。纵向信号延伸和相关的神经外损伤也与较差的预后相关。单纯神经损伤的病例可采用保守治疗，但相关的神经外损伤，尤其是椎间盘突出和韧带不稳定，需要手术治疗。

关键词

创伤后脊髓病；脊髓损伤；计算机断层扫描；磁共振成像；无放射学异常的脊髓损伤

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/c0e92c811e09/jocmr-01-165-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/40351bfda5eb/jocmr-01-165-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/e1f0b895cd93/jocmr-01-165-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/09c8bc3136b8/jocmr-01-165-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/0ca3ee60f711/jocmr-01-165-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/e0952998fad2/jocmr-01-165-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/c0e92c811e09/jocmr-01-165-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/40351bfda5eb/jocmr-01-165-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/e1f0b895cd93/jocmr-01-165-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/c1fdbb629ef0/jocmr-01-165-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/1cf23af13f04/jocmr-01-165-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/09c8bc3136b8/jocmr-01-165-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/0ca3ee60f711/jocmr-01-165-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/e0952998fad2/jocmr-01-165-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38ac/3318880/c0e92c811e09/jocmr-01-165-g008.jpg

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