Atesok Kivanc, Tanaka Nobuhiro, O'Brien Andrew, Robinson Yohan, Pang Dachling, Deinlein Donald, Manoharan Sakthivel Rajaram, Pittman Jason, Theiss Steven
Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan.
Adv Orthop. 2018 Jan 4;2018:7060654. doi: 10.1155/2018/7060654. eCollection 2018.
"Spinal Cord Injury without Radiographic Abnormality" (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. 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. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.
“无放射学异常的脊髓损伤”（SCIWORA）是一个术语，指创伤后脊髓损伤的客观临床体征，而在脊柱的X线平片和计算机断层扫描（CT）上没有骨折或排列不齐的证据。SCIWORA最常见于儿童，由于儿童期颈椎活动度增加、韧带固有松弛以及头身比例较大，故颈椎脊髓更易受累。然而，SCIWORA在成人中也可见到，在罕见情况下，胸腰段脊髓也会受到影响。磁共振成像（MRI）已成为SCIWORA患者的一种有价值的诊断工具，因为它能够更好地识别软组织损伤，如脊髓水肿、血肿和横断伤，以及在X线平片和CT上可能无法显示的椎间盘韧带损伤。SCIWORA患者的主要治疗方法是非手术治疗，包括类固醇治疗、固定以及避免可能增加病情加重或再次受伤风险的活动。尽管手术治疗在SCIWORA中的作用可能存在争议，但对于有临床和MRI证据表明存在持续性脊髓压迫和不稳定的特定患者，应考虑手术选择，如减压和融合术。
