title: Spinal cord injury without radiographic abnormality (SCIWORA) in adults: MRI type predicts early neurologic outcome.
abstract: OBJECTIVE
  The present study aimed to analyse the clinical and neuroimaging features of a consecutive series of adult patients with spinal cord injury without radiographic abnormality (SCIWORA) receiving early magnetic resonance imaging (MRI), and to apply the recently proposed MRI classification system.
  
  
  METHODS
  Grade of neurologic impairment at admission and discharge was reported according to the American Spinal Injury Association Impairment Scale (AIS). A detailed analysis and categorisation of the extra- and intramedullary MRI findings was performed, and the relationship between imaging type and neurological outcome was described.
  
  
  RESULTS
  Twenty-six adult patients (17 male and 9 female) with SCIWORA were identified (mean age of 52 years). The distribution of the initial AIS grade was 8% A (n=2), 19% B (n=5), 31% C (n=8) and 42% D (n=11) at admission and 15% (n=4) C, 58% (n=15) D and 27% (n=7) E at discharge, respectively. Type I SCIWORA was found in 23% (n=6) and type II in 77% (n=20) (IIa: 0%, IIb: 25%, IIc: 75%). The mean improvement of AIS grade in patients with type I lesions was 1.5 (median 1, range 1-3) and 0.9 (median 1, range 0-3) in type II.
  
  
  CONCLUSIONS
  The findings underline the prognostic role of early MRI for adult patients with SCIWORA and support the use of the recently introduced MRI classification system.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: C K
authors.initials: CK
authors.lastname: Boese
authors.affiliation: Department of Radiology, University of Cologne, Cologne, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Müller
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Bröer
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Eysel
authors.affiliation: Department of Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Krischek
authors.affiliation: Department of Neurology, University Hospital of Cologne, Cologne, Germany.
authors.forename: H C
authors.initials: HC
authors.lastname: Lehmann
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Lechler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D013119:Spinal Cord Injuries / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D015599:Trauma Severity Indices; D055815:Young Adult