Traumatic Spinal Cord Injury Without CT or Radiographic Abnormality—An Under-Recognized Entity

Abstract

Traumatic spine injury most commonly presents as fracture, dislocation, and ligamentous injury, any of which may lead to spinal cord injury. Most traumatic spine injuries can be detected on first-line imaging examinations, currently CT and radiography (when CT is not available or in low-risk patients). CT and radiography of the spine provide excellent evaluation of acute fractures and malalignment, which also may suggest ligamentous injury. In a small number of patients, however, spinal cord injury may be present without obvious CT or radiographic evidence of acute injury. This type of spinal cord injury is underrecognized. Even when an MRI study is performed, the findings may be misdiagnosed as chronic myelomalacia. Because of the potential devastating consequence of delayed or missed diagnosis, increased awareness of this entity is warranted. This article reviews the clinical presentation, mechanism of injury, imaging findings, and prognosis of spinal cord injury without CT or radiographic abnormality (SCIWOCTRA)., (C) 2008 Lippincott Williams & Wilkins, Inc.