Page 19 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Spinal cord injury without radiological abnormalities

4. Imaging examination on MRI, leading to their classification as “real
SCIWORA” [9,13,28] . The “real SCIWORA” syndrome is
Accurate imaging is vital for diagnosing SCIWORA in a condition that necessitates a complete spinal MRI to
children. This section explores imaging techniques and rule out structural and potentially dangerous causes
their role in diagnosis and management. of neurologic dysfunction . Furthermore, various
[33]
i. X-ray imaging: The essential steps involve performing quantitative MRI techniques, including diffusion
anterior-posterior, lateral view, and open-mouth tensor imaging (DTI), can indicate micropathological
X-rays. While X-ray imaging shows the alignment of changes in white matter (WM) by observing the
the spinal column, it may not be sufficient for detecting diffusion direction and distribution of water molecules.
many pathological changes in cases of SCIWORA. More precisely, DTI provides an evaluation of injury
ii. CT scans serve as the gold standard for evaluating and severity, location, and classification [34-38] . However,
screening spine fractures, offering superior sensitivity to confirm a SCIWORA diagnosis, it is essential to
and specificity in detecting bone abnormalities . conduct multiple MRI examinations or incorporate
[19]
They offer enhanced and accurate details for other imaging techniques, such as MRA.
identifying fracture types and bony abnormalities .
[20]
The use of multi-detector CT not only improves 5. Diagnosis
precision but also accelerates imaging compared to
older CT technologies, making it an effective method The diagnosis of SCIWORA should be based on an
for detecting vertebral fractures . In addition, axial evaluation of the patient’s symptoms and, subsequently, an
[21]
and 3D views in the CT scans are valuable tools for assessment of the stability of the bony structures, with the
illustrating spinal canal shape, assessing facet joint exclusion of fractures, dislocations, soft-tissue injuries, and
stability, and distinguishing small, hidden lesions that micropathological changes as revealed by MRI scans. It is
may not be apparent on X-ray images [22,23] . imperative to differentiate SCIWORA from other potential
iii. MRI becomes a routine examination when X-ray and conditions such as arteriovenous malformation, multiple
CT results are normal, and it is the preferred method sclerosis, acute transverse myelitis, acute disseminated
for determining the integrity, location, severity, and encephalomyelitis, infarction, and intramedullary neoplasms
involvement of structures such as the intervertebral during the diagnostic process. The severity of SCIs is
disk, ligaments, cauda equina, and nerve roots [24,25] . currently categorized based on the ASIA grading system and
The T2-MRI signal allows for differentiation between MRI findings [39-41] . The ASIA grades are as follows:
edema, contusion, or ischemia (high signal) and i. Grade A: Complete loss of motor and sensory function
hemorrhage (low signal), making the T2-MRI image below the injury site.
the most valuable diagnostic tool for SCIWORA ii. Grade B: Sensory incomplete injury, where neither
diagnosis [26,27] . Moreover, it is essential not to restrict sensory nor motor function is maintained below the
MRI to a single vertebral level . MRI stands as the injury level or on either side of the body, and no motor
[28]
best choice for assessing the severity of SCIWORA, function is preserved for more than three levels below
and it is important to perform MRI examinations the injury site.
at every follow-up visit . In addition, performing iii. Grade C: Motor incomplete injury, characterized by
[29]
follow-up MRIs can reveal dynamic pathological preserved motor function below the injury level, with
changes in the spinal cord. Examining the entire spine more than half of key muscle functions graded at <3 at
can be particularly helpful in identifying soft-tissue a single level below the injury.
injuries and micropathological abnormalities. Early iv. Grade D: Motor incomplete injury, which is similar to
MRI scans offer some advantages, especially in cases of grade C but involves a higher degree of preserved key
severe injury, that may reveal pathological changes . muscle function, with muscle grades exceeding three.
[30]
The extent of edema on MRI is not consistent with v. Grade E: A return to normal function, where all
neurological injury level. In certain cases, features of sensory and motor function segments are classified as
spinal cord abnormalities may only become apparent normal in a patient who previously exhibited deficits.
[31]
on MRI after 1 – 2 days . The timing of MRI scans However, it is important to note that there are
has proven to be critical; serial scans can detect active limitations in applying the ASIA classification system
intramedullary and extramedullary lesions and signal to young children, and accurately assessing the severity
variations, or previously undetected anomalies. and ASIA grade of SCI in pediatric patients is difficult.
MRI is capable of revealing transaction, contusive Therefore, repeated assessments of neurological function
hemorrhage, traumatic edema, and concussion . are important. Moreover, a 72-h examination provides
[32]
Many cases of SCIWORA showed no abnormalities a more accurate prediction of outcomes in patients with

Volume 7 Issue 1 (2024) 3 https://doi.org/10.36922/itps.1386