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Delayed Onset of Thoracic SCIWORA in Adults
Man-Choon Park1, Soo-Kyung Bok, Soo-Jin Lee
1Department of Physical Medicine and Rehabilitation, Konyang University College of Medicine, Daejeon 371-718, Korea.
Annals of Rehabilitation Medicine
|January 24, 2013
Summary
This case study highlights a rare instance of thoracic spinal cord injury without radiographic abnormality (SCIWORA) in an adult. Early diagnosis and treatment improved patient mobility and continence.
Area of Science:
- Neurology
- Orthopedic Surgery
- Radiology
Background:
- Spinal cord injury without radiographic abnormality (SCIWORA) is a rare condition, accounting for 1-9% of all spinal cord injuries.
- While common in children with cervical SCIWORA, thoracic SCIWORA with delayed onset in adults is significantly less frequent.
- This abstract details a unique case of adult thoracic SCIWORA.
Purpose of the Study:
- To report a rare case of adult thoracic SCIWORA.
- To discuss the diagnostic challenges and treatment outcomes for this condition.
Main Methods:
- A case study of a 38-year-old male with progressive lower extremity weakness and sensory deficits.
- Diagnostic workup included whole spine and lumbar MRI, electrodiagnostic studies (NCS, SEP).
- Treatment involved steroid therapy and a 2-week rehabilitation program.
Main Results:
- MRI and NCS were normal, but SEP showed abnormalities in both tibial nerves.
- Following treatment, the patient showed improvement in lower extremity strength (G4 to G3), regained bladder continence, and could ambulate with a cane.
- The patient's condition progressed from wheelchair dependence to cane ambulation.
Conclusions:
- Thoracic SCIWORA in adults, though uncommon, should be considered in cases of unexplained neurological deficits after trauma.
- Abnormal somatosensory evoked potentials (SEP) can be a crucial diagnostic marker when imaging is inconclusive.
- Prompt diagnosis and management, including steroids and rehabilitation, can lead to significant functional recovery in adult SCIWORA.
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