Spinal cord injury without radiographic abnormality

Spinal cord injury without radiographic abnormality (SCIWORA) is a spinal cord injury (SCI) with no evidence of injury to the spinal column present on radiographs. Spinal column injury is trauma that causes fracture of the bone or instability of the ligaments in the spine; this can coexist with or result in injury to the spinal cord itself but each injury can occur without the other. Abnormalities might show up on magnetic resonance imaging (MRI), but the term was coined before MRI was in common use.

SCIWORA may present as a complete spinal cord injury (total loss of sensation and function below the lesion) or incomplete spinal cord injury (some sensation and/or function is preserved). It is present in a significant number of children with SCI. It was first described in children with a clinico-radiological mismatch by Pang and Wilberger. Later, a similar condition was reported in adults. It is most common in children. There seem to be relevant differences between pediatric and adult SCIWORA. In particular, adults often present with degenerative changes of the spinal column resulting in predisposing spinal stenosis. SCI in adults could be due to instability of vertebral ligaments or a herniation of a disk or a hematoma around the spinal cord that presses on it—none of which would show up on X-rays. In older people, spondylosis or problems with blood vessels can cause SCIWORA. The most common cause is being hit by a vehicle while on foot.