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Spinal Cord Injury without Radiographic Abnormality: Results of the National Emergency X-Radiography Utilization Study in Blunt Cervical Trauma

Hendey, Gregory W. MD; Wolfson, Allan B. MD; Mower, William R. MD, PhD; Hoffman, Jerome R. MA, MDfor the National Emergency X-Radiography Utilization Study Group

The Journal of Trauma: Injury, Infection, and Critical Care: July 2002 - Volume 53 - Issue 1 - p 1-4
Original Articles

Background  The purpose of this study was to better define the incidence and characteristics of patients with spinal cord injury without radiographic abnormality (SCIWORA), using the database of the National Emergency X-Radiography Utilization Study (NEXUS).

Methods  This was a prospective, observational study of blunt trauma patients in 21 U.S. medical centers undergoing plain cervical radiography. SCIWORA was defined as spinal cord injury demonstrated by magnetic resonance imaging, when a complete, technically adequate plain radiographic series revealed no injury.

Results  Of the 34,069 patients entered, there were 818 (2.4%) with cervical spine injury, including 27 (0.08%) patients with SCIWORA. Over 3,000 children were enrolled, including 30 with cervical spine injury, but none had SCIWORA. The most common magnetic resonance imaging findings among SCIWORA patients were central disc herniation, spinal stenosis, and cord edema or contusion. Central cord syndrome was described in 10 cases.

Conclusion  In the large NEXUS cohort, SCIWORA was an uncommon disorder, and occurred only in adults.

From the University of California San Francisco–Fresno, University Medical Center (G.W.H.), Fresno, University of California Los Angeles Medical Center (W.R.M, J.R.H.), Los Angeles, California, and the University of Pittsburgh (A.B.W.), Pittsburgh, Pennsylvania.

Submitted for publication December 19, 2001.

Accepted for publication February 11, 2002.

Supported by Agency for Healthcare Research and Quality grant R01 HS08239.

Address for reprints: Gregory W. Hendey, MD, University Medical Center, 445 South Cedar Avenue, Fresno, CA 93702; email:

© 2002 Lippincott Williams & Wilkins, Inc.