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  • Title: Early magnetic resonance imaging in spinal cord injury without radiological abnormality in adults: a retrospective study.
    Author: Boese CK, Nerlich M, Klein SM, Wirries A, Ruchholtz S, Lechler P.
    Journal: J Trauma Acute Care Surg; 2013 Mar; 74(3):845-8. PubMed ID: 23425746.
    Abstract:
    BACKGROUND: The purpose of this study was to describe the clinical and imaging characteristics of patients experiencing blunt spinal trauma without radiological abnormalities but transient or persistent neurological deficits. METHODS: This retrospective study analyzed plain radiographs, computed tomographic scans, and magnetic resonance images of patients with spinal cord injury without radiological abnormality (SCIWORA) who were admitted to a Level I trauma center. Neurologic status, Frankel grade, and short-term patient outcome were assessed. RESULTS: Of 1,604 patients experiencing blunt spinal trauma, 21 (12 men and 9 women) with a mean age of 35.5 years (range, 16.2-70.9 years) presented with a clinicoradiographic mismatch. Magnetic resonance imaging (MRI) was available in 15 patients. In seven patients (46.6%), MRI revealed either neural (n = 2, 13.3%) or extraneural (n = 5, 33.3%) spinal abnormalities. Importantly, in eight patients (53.3%), no spinal abnormalities were visible on MRI. Furthermore, subgroup analysis revealed no prognostic value regarding the presence or absence of detectable spinal injuries. CONCLUSION: Spinal abnormalities were not detected on MRI in a substantial proportion of patients presenting with SCIWORA. The prognostic value of MRI findings in SCIWORA needs to be validated by future studies. LEVEL OF EVIDENCE: Epidemiological study, level V.
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