HWN Suggests

C-Spine Clearance in the ED: When to ditch the collar

Spinal cord injury without radiographic abnormality (SCIWORA) is rare but feared. Thankfully, about <1% of patients with SCIWORA require surgical stabilization from an injury found on MRI but CT was negative. Suspect SCIWORA in those with severe neck pain or upper extremity neurologic deficits. Both the East and West Trauma Guidelines state that negative CT is adequate in the absence of focal neurologic deficits, and persistent midline pain alone is not an indication for MRI. MRI should be performed for these patients when the initial CT C spine is negative. A negative cervical MRI allows the clinician to clear the C spine at bedside.

read full article

Articles of Interest

Lightning Learning: SCIWORA

Neurological symptoms persisting despite normal radiographic images on x-ray or CT of the spine is an indication for an MRI to rule out a cord injury. Occurs more often in children. Mainly affects the cervical spine.

Podcast #72: SCIWORA

This type of injury occurs most often in children because they have a head that is too large for their body acting as a fulcrum to pull their neck. This is exacerbated in children with Down’s syndrome. For children under eight-years-old with a non-focal neurological exam, the chance that they have a cervical spine injury is arguably zero. Children will almost always present with some neurological deficit.

SCIWORA in Pediatric Trauma Patients

Pediatric spines are elastic in nature. SCIWORA is a syndrome with neurological deficits without osseous abnormality on XR or CT. Many patients with SCIWORA have myelopathy.

SCIWORA is Not Just Child’s Play: Analysis of the NEXUS Data

Using strict, objective criteria, we found that SCIWORA was an uncommon disorder, and occurred only in adult patients in the large NEXUS cohort. This is likely due to a much higher overall incidence of SCI in adults compared to children.

The Utility of MRI in the ED

MRI is less sensitive and specific for bony injury in acute trauma, with a sensitivity of 76% and specificity of 95% for acute fracture lines. The time-consuming nature of MRI likewise precludes its use in acute traumatic settings. The utility of MRI in spinal trauma is in the evaluation of soft tissue injury that is not well assessed with CT imaging