Abstract
Patients with spinal cord injury without radiographic abnormality (SCIWORA) are prone to develop spinal deformities. The purpose of this study is to report on the clinical and radiological features of post-SCIWORA spinal deformities. Four patients with SCIWORA and spinal deformities requiring surgery were analyzed clinically and radiographically. All four SCIWORA patients developed progressive neuromuscular scoliosis. There were 2 males and 2 females. The mean age at spinal cord injury was 3.9years (range 6months to 7years). Spinal deformity was first noticed at a mean of 17months after their initial injury (range 9months to 2years), and surgical intervention was performed at a mean of 6.5years following their injury (range 4-11years). The mean preoperative curve was 54° (range 50-62°). The mean postoperative curve was 9.5° (range 5-16°). The level of injury was T5 in two patients, and T10 and L2 in one patient each. All but the lumbar level injury patient had complete paraplegia. One patient with complete injury (T10) and another with incomplete injury (L2) improved neurologically and were able to walk with the aid of orthoses and crutches. Pelvic obliquity improved in all patients following spinal reconstruction surgery, and none of the patients required additional surgery for spinal deformity. The mean postoperative follow-up was 51.75months (range 24-93months). Long scoliotic curves extending to the pelvis should be expected in SCIWORA. Early intervention may prevent severe deformities. Modern instrumentation techniques employing pedicle screws provided satisfactory correction, improved hip subluxation, and did not adversely affect the ambulatory ability or functional level of the patients in this series.
Highlights
Similar clinical entities have been reported previously, spinal cord injury without radiographic abnormality (SCIWORA) was first defined with its acronym by Pang and Wilberger in 1982 as ‘‘objective signs of myelopathy as a result of trauma, whose plain films of the Normal radiographic findings make the diagnosis challenging [10, 11]
There are some unique characteristics in pediatric patients that have been proposed to explain the higher incidence of SCIWORA in this age group
Horizontal orientation of the facet joints, anterior wedging of the superior aspects of the vertebral bodies, weakness of the paravertebral muscles, and the elasticity of ligaments and joint capsules are some of the features of the pediatric spinal column that predispose to SCIWORA [7, 8, 11, 12]
Summary
N. Yalcin Department of Orthopaedics and Traumatology, Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey. A. Alanay Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul Spine Center, Florence Nightingale Hospital, Bilim University, Abide-i Hurriyet cad. Axial muscle imbalance and/or weakness are recognized as the causes of spinal deformities in these disorders [1]. These disorders include a wide variety of etiologies, pathogeneses, natural histories and associated disorders [3]. The rarity of some of these disorders, such as spinal cord injury without radiographic abnormality (SCIWORA), has prevented the creation of a large patient series with long-term follow-up. Patients with spinal cord injury without radiographic abnormality (SCIWORA) are prone to develop spinal deformities. The purpose of this study is to report on the clinical and radiological features of postSCIWORA spinal deformities
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