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Spinal Cord Injury without Radiographic Abnormality 952

 

synonyms:Spinal Cord Injury without Radiographic Abnormality (SCIWORA)

SCIWORA ICD-9

  • 952 Spinal cord injury without evidence of spinal bone injury
  • 952.xx  Codes 952.0 through 952.9 denote levels involved and specific cord syndrome

SCIWORA Etiology / Epidemiology / Natural History

  • Etiology unknown; may involve hyperlaxity or transient vascular compromise.
  • Most commonly involves the cerivical spine in young children. May involve thoracolumbar spine in older children.

SCIWORA Anatomy

SCIWORA Clinical Evaluation

SCIWORA Xray / Diagnositc Tests

  • neck, shoulder, arm pain, paresthesias and numbness, occipital headache
  • Spurling’s test positive(increased symptoms with rotation and lateral bend with a vetical compressive force)
  • C2: extremely rare-jaw pain and occipital headaches, but no motor deficit is seen.
  • C3: most often caused by disk disease at C2-3, is not common-headaches and pain along the posterior aspect of the neck that extends to the posterior occipital region and occasionally to the ear. There are no motor deficits,. DDX:tension headaches.
  • C4: typically C3-4 HNP-neck and trapezial pain, no motor deficits, and diaphragmatic involvement has not been well documented. Patients occasionally complain of numbness and pain at the base of the neck that extends to the shoulder and scapular region.
  • C5: pain and/or numbness in an “epaulet” pattern that includes the superior aspect of the shoulders and the lateral aspect of the upper arm. Deltoid motor function is often weakened, as in an intrinsic shoulder disorder; the diagnosis of radiculopathy at this site is crystallized by observing the absence of impingement signs or pain with passive shoulder motion. Patients may complain of difficulties with activities of daily living if there is involvement of the supraspinatus, infraspinatus, or elbow flexors. Depression of the biceps reflex is an inconsistent finding.
  • C6: pain or sensory abnormalities extending from the neck to the biceps region, down the lateral aspect of the forearm to the dorsal surface of the hand, between the thumb and index finger, and including the tips of these fingers. The brachioradialis reflex may be depressed, and wrist extensor weakness is usually present. The infraspinatus, serratus anterior, triceps, supinator, and extensor pollicis muscles may also be affected.
  • C7: most common. Pain and sensory abnormalities extend down the posterior aspect of the arm and the posterolateral aspect of the forearm and typically involve the middle finger, which is rarely affected in C6 disorders. Absence of the triceps reflex is common, and triceps weakness is almost always present. The wrist flexors, wrist pronators, finger
  • extensors, and latissimus dorsi may also be affected.
  • C8: least likely to be associated with pain. Sensory changes usually restricted to
  • below the wrist; interossei motor involvement.  DDX: ulnar neuropathies, intrinsic hand disorders, myelopathy.

SCIWORA Classification / Treatment

  • Brace the affected level (cervical/thoracolumbar) for 3 months.
  • May not demostrate neurologic progression for several days.

SCIWORA Associated Injuries / Differential Diagnosis

SCIWORA Complications

SCIWORA Follow-up Care

SCIWORA Review References

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