Delayed Onset of Thoracic SCIWORA in Adults

Annals of Rehabilitation Medicine, 2012 · DOI: 10.5535/arm.2012.36.6.871 · Published: December 1, 2012

Simple Explanation

Spinal cord injury without radiographic abnormality (SCIWORA) is a condition where there is spinal cord injury without any visible damage on X-rays or CT scans. This is more commonly seen in the cervical spine of children. This case report describes an adult male who experienced a fall and initially had back pain, but later developed weakness in his lower extremities, a condition known as delayed onset paralysis. The weakness progressed, and he also experienced other symptoms such as impotence and hypoesthesia. The patient received steroid therapy and rehabilitation, which led to some improvement in his strength and bladder function, allowing him to ambulate with a cane. This case highlights the possibility of SCIWORA in adults, even with minor trauma.

Study Duration

2 weeks

Participants

1 male patient

Evidence Level

Level 4: Case Report

Key Findings

1
The patient, a 38-year-old male, experienced delayed onset of lower extremity weakness 7 days after a fall, which progressed and was diagnosed as thoracic SCIWORA.
2
MRI findings were initially unremarkable, but somatosensory evoked potential (SEP) studies showed abnormalities, indicating spinal cord dysfunction despite the lack of radiographic evidence.
3
Steroid therapy and rehabilitation led to improvement in muscle strength and bladder function, enabling the patient to ambulate with a cane, demonstrating the potential for recovery in delayed-onset SCIWORA cases.

Research Summary

This case report presents a rare instance of delayed-onset thoracic SCIWORA in a 38-year-old male following a fall. The patient initially presented with back pain but developed progressive lower extremity weakness and sensory deficits days after the injury. Despite normal initial MRI findings, electrodiagnostic studies revealed abnormalities, leading to a diagnosis of SCIWORA. The patient underwent steroid therapy and rehabilitation, resulting in functional improvement. The case underscores the importance of considering SCIWORA in adults with delayed neurological symptoms after trauma, even in the absence of radiographic abnormalities, and highlights the potential for improvement with appropriate management.

Practical Implications

Clinical Awareness

Clinicians should be aware of the possibility of SCIWORA in adults, even with minor trauma and delayed onset of symptoms.

Diagnostic Vigilance

Employ electrodiagnostic studies like SEP when MRI findings are initially normal, but clinical suspicion of SCI remains.

Rehabilitation Potential

Early and appropriate rehabilitation can lead to functional improvement in patients with delayed-onset SCIWORA.

Study Limitations

1
Single case report limits generalizability.
2
Lack of long-term follow-up data.
3
Possibility of additional trauma before hospitalization cannot be completely ruled out.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury