Associated Factors of Cervical Spinal Cord Injury Without Radiographic Evidence of Trauma: A Retrospective Study

Cureus, 2025 · DOI: 10.7759/cureus.80006 · Published: March 4, 2025

Simple Explanation

Spinal cord injury without radiographic evidence of trauma (SCIWORET) is a condition where a person has a spinal cord injury, but X-rays and other imaging don't show any broken bones or dislocations. The study aimed to find out what factors might make someone more likely to experience SCIWORET, focusing on issues like a narrow spinal canal or problems with ligaments in the neck. The study found that having a narrow spinal canal (CCS) and ossification of the posterior longitudinal ligament (OPLL) were linked to a higher chance of SCIWORET.

Study Duration

April 2011 and November 2023

Participants

348 patients with C3-C7 cervical SCI

Evidence Level

Not specified

Key Findings

1
CCS was present in 85.7% of the SCIWORET group compared to 53.8% in the SCI with fracture group (p < 0.0001).
2
Cervical OPLL was more prevalent in the SCIWORET group (33.5% vs. 16.6%, p < 0.001).
3
Multivariate logistic regression analysis revealed that CCS (OR: 4.91, 95% CI: 2.78-8.70, p < 0.0001) and cervical OPLL (OR: 1.83, 95% CI: 1.01-3.29, p < 0.05) were independent predictors of SCIWORET.

Research Summary

This retrospective study investigated factors associated with SCIWORET in cervical SCI patients, focusing on CCS, cervical OPLL, and DISH. The study found that CCS and cervical OPLL were independent predictors of SCIWORET, emphasizing the importance of comprehensive spinal evaluation in trauma patients. The findings suggest that patients with pre-existing CCS or OPLL may be at increased risk for SCI, even in the absence of obvious radiographic abnormalities.

Practical Implications

Comprehensive Spinal Evaluation

Emphasizes the need for thorough spinal assessments in trauma patients, especially those with neurological symptoms after minor trauma.

Early MRI Consideration

Suggests considering early MRI for trauma patients exhibiting neurological symptoms, particularly when CCS or OPLL is suspected.

Risk Stratification

Recommends risk stratification to guide clinical decisions, potentially improving early diagnosis and patient outcomes.

Study Limitations

1
Retrospective design and inclusion of only trauma patients may introduce selection bias.
2
Inability to assess pre-injury flexibility and balance.
3
The presence of CCS may represent post-traumatic spinal cord edema rather than a pre-existing anatomical condition.

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