Total Community Care - Specialists in spinal & neurological care

Providing bespoke care nationwide for clients with spinal injuries and neurological conditions

30 Jul

Spinal Injury without Radiographic Abnormalities

Sometimes, traditional imaging with x-ray or CT scan does not find a clear physical cause for the spinal cord injury symptoms the patient is experiencing – no injuries to the vertebrae or other obvious physical damage around the spine. This is known as ‘spinal injury without radiographic abnormalities’, or ‘SCIWORA’. Sometimes the terms ‘neuroimaging’ or ‘imaging’ may be used in place of ‘radiographic’.

Someone presenting to hospital with acute symptoms that suggest a spinal cord injury may be experiencing loss of movement, bladder and bowel control, sensation, and possibly problems breathing independently. A spinal cord injury (SCI) is most likely to occur following some traumatic incident – a car accident, for example, or a fall from a height. There may be some bruising or obvious signs of trauma, or it may be only the physical changes that suggest an SCI. A suspected spinal cord injury is always a medical emergency and must receive paramedic and hospital treatment immediately.

In general, spinal cord injuries are suspected when someone presents with some of the many symptoms of a spinal cord injury, and this is confirmed by medical imaging. X-rays and computed tomography (CT) scans are common, non-invasive ways of confirming and investigating a spinal injury.

Although an x-ray or CT scan may not show any damage to the bones and tissues around the suspected injury, medical imaging has improved since the first distinction between SCI with and without radiographic abnormalities, and a magnetic resonance imaging  (MRI) scan will almost always show damage even when only the spinal cord has been injured.

Common diagnostic use of MRI scans as a medical imaging option has led to discussion within the medical community over whether the term ‘without radiological abnormalities’ is still appropriate, now that a pure spinal cord injury can, in fact, be radiologically identified.[i]

X-Ray vs. MRI scan of spinal cord injury

SCIWORA is very rare in adulthood – this is because the bones and processes of the adult spinal column are much more fixed and inflexible than in childhood. This means that a spinal cord injury in an adult is almost always accompanied by damage to the bones and surrounding structures – in other words, a spinal cord injury with surrounding injuries that are visible on traditional medical imaging such as CT scans.

Who is likely to sustain a spinal injury without radiographic abnormalities?

SCIWORA is much more common in childhood and extremely uncommon in people over the age of 18. SCIWORA actually accounts for something between 15% and 42%[ii] of spinal cord injuries in people aged 18 and under – this wide range is because the incidence of SCIWORA among children and adolescents with SCI varies greatly according to the age of the child. In general, the younger the child who suffers a spinal cord injury, the more likely it is to be unaccompanied by bone injuries, and SCIWORA is much more common again in children younger than 8[iii].

The main reason for the higher risk for children is thought to be the fact that young children’s spinal ligaments and intravertebral discs are flexible and elastic, and so provide less protection to the spinal cord. A back trauma – a car injury or sports injury, for example – sustained by someone with a very elastic spine can cause damage to the spinal column without significantly damaging any part of the backbone or cartilage.

Where adults experience a SCIWORA, they are more likely to have a non-traumatic underlying cause, such as degenerative changes causing pressure on the spinal cord or problems with blood supply, such as venous congestion.[iv]

The age of the child can also influence the area of the spinal cord damaged, with younger children more likely to have injuries higher up the spine than older children and adolescents[v]. This is thought to be due to a combination of a very elastic spine, weak neck muscles and the large head to body ratio of younger children. It is not hard to imagine the damage sustained by someone with a large, heavy head on a flexible, elastic spine during a car accident or other traumatic event, and younger children are therefore more likely to sustain very serious injuries with more significant long-term effects.[vi]

Spinal cord injury without radiographic abnormality sciwora

Image courtesy of Steven Frick MD & Timothy Moore MD

 

What are the results of an SCIWORA?

As with any spinal cord injury, the effects vary widely, and depend largely on the area of the injury and how much of the spinal cord is damaged at that point. As younger children tend to have higher spinal injuries, they are more likely to have profound changes to their ongoing ability.

SCIWORA is also seen, on occasion, to be recurrent. The likelihood of this depends on the mechanism of injury – it is thought to be more common where the spinal cord was damaged in such a way as to make it, or rather the surrounding bones and tissues, less stable in the long term.[vii] Anyone who has sustained an SCI is likely to have a significant hospital stay and so a recurrent SCI is likely to be during a period of close clinical monitoring and can be managed appropriately.

Can people recover from a SCIWORA?

All spinal cord injuries are different, so there is no answer that applies to everyone. Recovery potential varies case to case, and the only people who can really give an answer are the healthcare specialists involved in the immediate care of the person with an SCI.

People with a total or near total SCIWORA – in other words whose spinal cord nerves are too damaged to relay a useful amount of information – will almost always need significant extra support for life, and higher injuries in the neck or C-spine may mean that that person is dependent on support for all of their normal activities of daily living. Injuries to the high spinal cord can mean that a person becomes dependent on a ventilator for breathing and coughing.

Where there is less damage to the spinal cord, the injuries may be transient, and sometimes a full recovery can be made. A partial spinal cord injury may leave people with only minimal altered movement, control, or sensation. The effects of a partial spinal cord injury can affect one or both sides of the body, and can be very varied. Someone with a partial SCI may still have very profound support needs, or they may be only very slightly affected – people with the least severe spinal cord injuries may simply have slightly altered sensation, or may need to take extra care of their bladder or bowel control.

Spinal Cord Injury Without Radiographic Abnormalities

The full effects of SCIWORA can sometimes take up to 4 days to be fully realised, and anyone with a suspected spinal cord injury will be monitored very closely in hospital for some time. Immobilisation of the spine is one of the most important early treatments for anyone with a suspected SCI. As with any SCI, people with a SCIWORA which has significantly affected their ability to live independently may benefit from a stay in a neurological rehabilitation facility, where they can receive intensive physiotherapy, occupational therapy, and plan for the ongoing changes in their life. This period of time is also sometimes essential to ensure that an appropriate care package can be put in place for them going home, and adjustments to their home can be made.

Living with a SCIWORA

A serious spinal cord injury sustained in childhood is, naturally, an incredibly emotive thing – a child sustaining any trauma or serious illness will affect the whole family and may feel like a tragedy. There will be, of course, massive adjustments to make, but there’s more than one way to live a life, and the world is scattered with happy, successful people living with even the most profound injuries and continued care needs.

The professionals involved in the care and rehabilitation of people with spinal cord and neurological injuries should be able to point individuals and families affected by SCI towards support groups and resources to help them adjust to the changes. The internet can also be an incredibly useful tool in finding local or online support networks and advice about living with a SCIWORA. Parents and families of children with spinal cord injuries can also expect individualised support through what is bound to be an uncertain time. One of the most common concerns parents of young children with SCI have is over how much the child can understand, and how much they should be told. There’s no easy answer to this, but it’s something that the healthcare professionals involved in the care of children of all ages with SCI are very experienced in.

Even if they had exactly the same injury and effect, there are clearly huge differences in the types of support that children and adults need after an SCI. There are similarities too – anyone may need personal care, continence care, and the support of a team experienced in, for example, ventilator and tracheostomy care. The differences may include the type of activity that a care team will support the person through – whether schooling or work, family activities as a dependent child or as an independent adult, and a care team needs to be able to adapt to the changes anyone experiences through childhood and adolescence.

The dynamics of a family where someone has sustained an SCI, who now needs long-term support and has new restrictions in their activity and ability, can be complex and changeable. The roles and involvement that families take in the support of a person with extra needs is very varied. Parents may take a very active role in the support of a child with complex needs, or may be more comfortable with professional help always at hand. There is no right or wrong here – no standard amount of involvement that a care team expects from the family, only the love and attention that the child has always needed.

Care after a SCIWORA

A severe spinal cord injury sustained at any time of life will mean that some degree of extra medical, nursing, and social support is needed from that point onwards. The level and severity of injury is the main thing that should influence the sort of support someone gets – everyone should have the support they need to live their live the way they want to, and there are many resources with advice on funding and arranging levels of support.

The level of care someone might need after a spinal injury is wide-ranging. Someone may be able to live entirely independently, with or without physical aids to support mobility or continence issues. Others may require a team of carers who are trained in the management of ventilators, pressure area care and supporting people who require assistance with almost every physical need.

A dedicated care team is not just there to make up for new deficits in a person’s ability to care for themselves – they are there to enable that person to live the life they want. With an effective care team, some people with even the most profound injuries and needs can maintain a social life, a family life, a career, and – a question heard often by care providers – can go away on holidays, even while needing full-time support.

Total Community Care is a care provider with a difference – we help all our clients select their care team, giving them and their nearest and dearest complete control over the people they choose to give them support and care. That care team is able to support the client throughout their life, meaning that all care can continue to be given by the people they’ve chosen and grown to know and trust. TCC can create bespoke care packages for a minimum of around 70 hours a week, including 24-hour care packages with both waking and sleeping nights.

We specialise in spinal cord injury and neurological needs so our teams can be highly trained in their specialty. We work hard to have a highly specialised, happy and well supported workforce, meaning our teams provide the very best quality of care and support. We believe that quality of life after a neurological injury begins with having choice over the people who support you.

IMPORTANT NOTE

Total Community Care can only provide packages of care for individuals who are 18 years old and above. We are unable to provide packages of care for children.

 

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[i] https://doi.org/10.1016/j.clineuro.2008.02.004

[ii] https://online.boneandjoint.org.uk/doi/full/10.1007/s11832-016-0740-x

[iii] https://thejns.org/view/journals/j-neurosurg/57/1/article-p114.xml

[iv]https://journals.lww.com/jtrauma/Abstract/2008/07000/The_Adult_Spinal_Cord_Injury_Without_Radiographic.14.aspx

[v] https://www.hindawi.com/journals/aorth/2018/7060654/

[vi]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262055/#:~:text=High%2Denergy%20injuries%20are%20often,Launay%20et%20al.

[vii] https://journals.lww.com/jtrauma/Abstract/1989/05000/Spinal_Cord_Injury_without_Radiographic.21.aspx