Subscribe to RSS
DOI: 10.1055/s-0043-110228
SCIWORA – häufig oder überschätzt?
SCIWORA – frequent or overrated?Publication History
Publication Date:
24 August 2017 (online)
Zusammenfassung
Der Begriff SCIWORA wurde 1982 erstmals als eine Rückenmarksschädigung ohne erkennbare Verletzungszeichen in der damals verfügbaren apparativen Diagnostik beschrieben. Die Erweiterung der Bildgebung und deren verbesserte Qualität waren Wegbereiter für eine unbeständige Auslegung des Akronyms und für die Entstehung eines sehr heterogenen Patientenkollektivs. Trotz der Betonung des kindlichen SCIWORAs in der älteren Literatur wird in den aktuellen Publikationen eine Verschiebung der Häufigkeit hin zum adulten SCIWORA (SCIWORET) beobachtet. Damit wird das kindliche SCIWORA aus tradiertem Aspekt häufig überschätzt, wohingegen das SCIWORET nach den heutigen Inzidenzraten eher unterschätzt wird. Während das Therapieregime des kindlichen SCIWORA aus konservativen Maßnahmen besteht, bedarf das SCIWORET nach aktuellen Empfehlungen einer frühzeitigen operativen Therapie.
Abstract
The term SCIWORA was established for the first time in 1982 as a damage to the spinal cord without any recognizable injuries in the at that time available diagnostic methods. Improvement in imaging and expansion of diagnostic modalities has led to an inconsistent interpretation of the acronym and thus to a heterogeneous patient population. Despite the emphasis of the pediatric SCIWORA in the older literature, a shift in frequency has been observed to the adult SCIWORA (SCIWORET) in current publications. From a traditional aspect the pediatric SCIWORA is often overestimated, whereas the SCIWORET, according to today’s incidence rates, tend to be underestimated. While the treatment regimen of the pediatric SCIWORA consists of conservative measures, the SCIWORET requires early surgical treatment, according to current recommendations.
-
Literatur
- 1 Leventhal HR. Birth injuries of the spinal cord. J Pediat 1960; 56: 447-53
- 2 Pang D, Wilberger Jr JE. Spinal cord injury without radiografic abnormalities in children. J Neurosurg 1982; 57: 114-129
- 3 Yucesoy K, Yuksel KZ. SCIWORA in MRI era. Clin Neurol Neurosurg 2008; 110: 429-433
- 4 Dreizin D, Kim W, Kim JS. et al. Will the real SCIWORA please stand up? Exploring clinicoradiologic mismatch in closed spinal cord injuries. AJR Am J Roentgenol 2015; 205: 853-60
- 5 Sekhon LH, Fehlings MG. Epidemiology, demografics, and pathophysiology of acute spinal cord injury. Spine (Phila Pa 1976) 2001; 26: S2-S12
- 6 Hulsebosch CE. Recent advances in pathophysiology and treatment of spinal cord injury. Adv Physiol Educ 2002; 26: 238-255
- 7 Hayashi N, Green BA, Gonzalez-Carvajal M. et al. Local blood flow, oxygen tension, and oxygen consumption in the rat spinal cord: Part 2: Relation to segmental level. J Neurosurg 1983; 58: 526-530
- 8 Tator CH, Koyanagi I. Vascular mechanisms in the pathophysiology of human spinal cord injury. J Neurosurg 1997; 86: 483-492
- 9 Koyanagi I, Tator CH, Lea PJ. Three‐Dimensional Analysis of the Vascular System in the Rat Spinal Cord with Scanning Electron Microscopy of Vascular Corrosion Casts. Part 2: Acute Spinal Cord Injury. Neurosurgery 1993; 33: 285-292
- 10 Fehlings MG, Vaccaro AR, Boakye M. et al. , Hrsg. Essentials of spinal cord injury: basic research to clinical practice. Stuttgart: Thieme; 2012
- 11 Kirshblum SC, Burns SP, Biering-Sorensen F. et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med 2011; 34: 535-546
- 12 Stiell IG, Clement CM, McKnight RD. et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003; 349: 2510-2518
- 13 Andreoli C, Colaiacomo M, Rojas BM. et al. MRI in the acute phase of spinal cord traumatic lesions: Relationship between MRI findings and neurological outcome. Radiol Med 2004; 110: 636-645
- 14 Bozzo A, Marcoux J, Radhakrishna M. et al. The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma 2011; 28: 1401-1411
- 15 Aebli N, Rüegg TB, Wicki AG. et al. Predicting the risk and severity of acute spinal cord injury after a minor trauma to the cervical spine. Spine J 2013; 13: 597-604
- 16 Vale FL, Burns J, Jackson AB. et al. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 1997; 87: 239-246
- 17 Hagg T, Oudega M. Degenerative and spontaneous regenerative processes after spinal cord injury. J Neurotrauma 2006; 23: 263-80
- 18 Hurlbert RJ. Strategies of medical intervention in the management of acute spinal cord injury. Spine (Phila Pa 1976) 2006; 31: S16-S21
- 19 Neurologie DGf. S1-Leitlinie Querschnittlähmung. AWMF; 2012
- 20 La Rosa G, Conti A, Cardali S. et al. Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach. Spinal cord 2004; 42: 503-512
- 21 Fehlings MG, Vaccaro A, Wilson JR. et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PloS one 2012;
- 22 Dvorak MF, Fisher CG, Hoekema J. et al. Factors predicting motor recovery and functional outcome after traumatic central cord syndrome: a long-term follow-up. Spine (Phila Pa 1976) 2005; 30: 2303-2311
- 23 Bosch PP, Vogt MT, Ward WT. Pediatric spinal cord injury without radiografic abnormality (SCIWORA): the absence of occult instability and lack of indication for bracing. Spine (Phila Pa 1976) 2002; 27: 2788-2800
- 24 Pang D. Spinal cord injury without radiografic abnormality in children, 2 decades later. Neurosurgery 2004; 55: 1325-1343