Nadeson Yogeshwarran, Zakaria Amir Fariz
Department of Orthopedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Selangor, MYS.
Department of Orthopedics, Spine Unit, Hospital Sungai Buloh, Sungai Buloh, MYS.
Cureus. 2024 Dec 31;16(12):e76685. doi: 10.7759/cureus.76685. eCollection 2024 Dec.
Spinal cord injuries, including rare cases without radiological abnormalities, pose diagnostic challenges, particularly in cases of delayed neurological deficit development. This case report describes a 55-year-old man with a stable L1 burst fracture who developed delayed neurological deficits two weeks after sustaining a fall despite no evidence of intrinsic or extrinsic spinal cord abnormalities on magnetic resonance imaging (MRI). The patient initially presented with back pain, normal muscle strength across all myotomes, and imaging that showed no canal stenosis or retropulsion fragments. After symptom progression to bilateral lower limb weakness, urinary incontinence, and loss of anal tone, follow-up investigations, including MRI, electromyography, nerve conduction studies, and blood tests, were unremarkable. Although the clinical presentation appeared to indicate spinal cord injury without radiological abnormality (SCIWORA), the delayed onset of symptoms and structural abnormalities in this case fell outside traditional SCIWORA criteria. This case highlights a gap in the current terminology used to describe spinal cord injuries with delayed neurological presentation, emphasizing the need for more precise classification to inform diagnosis, management, and medicolegal documentation.
脊髓损伤，包括罕见的无放射学异常病例，带来了诊断挑战，尤其是在出现延迟性神经功能缺损的情况下。本病例报告描述了一名55岁男性，患有稳定的L1爆裂骨折，在跌倒后两周出现延迟性神经功能缺损，尽管磁共振成像（MRI）未显示脊髓内在或外在异常。患者最初表现为背痛，所有肌节的肌肉力量正常，影像学检查未显示椎管狭窄或后凸碎片。在症状进展为双侧下肢无力、尿失禁和肛门括约肌张力丧失后，包括MRI、肌电图、神经传导研究和血液检查在内的后续检查均无异常。尽管临床表现似乎表明为无放射学异常的脊髓损伤（SCIWORA），但该病例中症状的延迟出现和结构异常不符合传统的SCIWORA标准。本病例凸显了当前用于描述伴有延迟性神经表现的脊髓损伤的术语存在的差距，强调需要更精确的分类以指导诊断、管理和法医学记录。
