Non-locality and the misdiagnosis of Spinal Cord Injury Without Radiographic Abnormality: proof of concept

Spinal Cord Series and Cases, 2019 · DOI: https://doi.org/10.1038/s41394-019-0148-1 · Published: January 1, 2019

Spinal Cord Injury Medical Imaging Pediatrics

Simple Explanation

This paper challenges the assumption in traumatic SCI, which led to the SCIWORA hypothesis, i.e., the notion we call “locality” that states if any SCI occurs, then any causal spinal column injury must be in the immediate vicinity. To explain cases of SCI when no local spinal column injury is present, the SCIWORA hypothesis postulates that the pediatric spinal column is inherently lax, i.e., the spinal column has more physiologic ﬂexibility than the spinal cord. We present a case series misdiagnosed as SCIWORA to demonstrate the existence of non-locality, meaning the SCI and the spinal column uncoupling or damage need not occur in the same location.

Study Duration

5 years

Participants

6 SCI patients: 3 pediatric and 3 adult

Evidence Level

Retrospective review

Key Findings

1
Six SCI patients with a residual diagnosis of SCIWORA were identiﬁed, 3 pediatric and 3 adult. All had injuries ﬁtting non-locality. None were an actual SCIWORA.
2
Source data do not appear to support the SCIWORA hypothesis.
3
Borrowing from quantum mechanics, we reveal non-locality as a real entity in the spine. The assumption of locality-only is invalid and likely contributed to the SCIWORA hypothesis for the pediatric spine.

Research Summary

This study challenges the assumption that spinal cord injuries (SCI) must occur in the same location as the spinal column injury, a concept called "locality," which led to the SCIWORA hypothesis. The authors present a case series of patients misdiagnosed with SCIWORA to demonstrate "non-locality," where SCI and spinal column damage don't necessarily occur at the same location. The study suggests that the SCIWORA hypothesis may have arisen from the failure to recognize non-locality and that the literature cited as evidence for SCIWORA lacks empirical support.

Practical Implications

Improved Diagnosis

Recognizing non-locality can improve the accuracy of SCI diagnoses, reducing misdiagnosis of SCIWORA.

Targeted Treatment

Identifying the actual causative spinal column injury, even if distant, allows for more targeted and effective treatment strategies.

Cost Reduction

Avoiding unnecessary bracing and surgery, based on a misdiagnosis of SCIWORA, can reduce healthcare costs.

Study Limitations

1
The literature search is subject to revision through time.
2
Limited by the initial 10-year time frame selected.
3
The degree to which the authors were able to read, trace, and adequately survey, interpret, and represent the hundreds of articles examined in reference to the claims under scrutiny.

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