Abstract

Background
Cervical spine injuries with or without spinal cord injury are the most commonly missed serious injuries, and the missed or delayed diagnosis may cause serious, catastrophic consequences for patients and have medico-legal implications for physicians. The diagnosis of subluxation or spinal cord injuries in the absence of vertebral fractures poses problems for physicians. The purpose of this study was to find the etiology, the clinical features, and imaging findings of unfractured cervical spine injuries, subluxations and spinal cord injuries without radiographic abnormality (SCIWORA). Methods: Between 1997 and 2002, 81 patients of cervical spine blunt trauma without fractures were enrolled. They underwent both simple cervical X-rays and magnetic resonance imaging (MRI) and were divided into three groups based on neurologic and radiologic findings: subluxation, SCIWORA, and normal. Data were obtained from a review of the medical records in the form of the National Emergency X-radiography Utilization Study (NEXUS) criteria. We investigated the causes of trauma, the clinical features, and the patterns of spinal cord injury in each group. Results : Among the 81 patients, subluxation accounted for 29, SCIWORA for 25, and normal for 27. The most common cause of the subluxation and SCIWORA was motor vehicle accidents, followed by falls. All patients had at least one of the NEXUS criteria. Central disc herniation and cord compression were common findings in patients with subluxation and SCIWORA. Conclusion: In our study, none of the patients had cervical spine fractures or serious malalignment. Also, none had severe craniofacial injuries or major multiple trauma, but all had spinal cord injuries. In adults with subluxation or SCIWORA, central disc herniation and spinal
stenosis played an important role.

• Keywords: Spinal cord injury, Subluxation, SCIWORA, Central disc herniation