A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma

Abstract

Spinal cord injury without radiographic abnormality (SCIWORA) is a well-documented finding in the paediatric population age groups, however in adults it is a rare occurrence. This case report gives an account of a case of an adult patient in whom a diagnosis of cervical SCIWORA was made and confirmed by MRI, following, seemingly, trivial trauma. A 46 year old man jumped from a small bridge, landed on his feet and fell backwards, immediately thereafter could no longer move or feel his trunk and limbs. Upon neurological assessment, he was found to have spastic quadriparesis, sensory level of C4, as well as bowel and bladder dysfunction. CT scan did not reveal any abnormalities; however MRI demonstrated spinal cord signal changes consistent with spinal cord contusion. Patient was managed conservatively in a rigid cervical collar, as well as per local protocols for the management of quadriplegia. He however eventually succumbed to respiratory failure compounded by aspiration pneumonia. Although SCIWORA is rare in the adult population groups, it does occur and can lead to significant morbidity and high mortality rates. Therefore adult patients presenting with neurologic deficits and normal static radiographs and CT scans, on a background of any degree of trauma, be it trivial, should not be brushed off lightly but rather investigated further with dynamic radiographs and MRI.