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SCIWORA - Spinal Cord Injury Without Radiographic Abnormality

Ilene Claudius, MD and Peter Gruen, MD
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18:26
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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02:41

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EM:RAP 2018 04 April Written Summary 535 KB - PDF

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Russell F. -

So if you get an MRI and its negative your done? No need for c-collar or follow up?

I have been CTing patients and if they still have midline cervical tenderness putting them in a miami j collar and having them follow up with neurosurgery in 1 week (for whatever it is either flex/ext films or MRI). I do have MRI capabilities readily available at my place although I wouldn't MRI any1 emergently unless they had neurological deficits on exam but just curious about the whole algorithm which I wasn't too clear on.

I guess my question also is an acute injury leading to myelopathy would show up on an MRI right away correct?

Tracy G. -

From Dr. Gruen:

Dear Dr. Russell,
If an MRI is negative, the C-spine is stable -- no need for surgery or a hard collar.
If the patient has persistent neck pain she/he can try a soft collar for comfort. Maybe some massage or hot compresses. P.O. analgesics.
If pain persists for weeks, maybe PT?
We also put patients with negative CT, normal neuro exam and neck pain in a hard collar and send home with follow up appointment with neurosurgery in a week. At that visit if pain resolved, collar comes off. If neck still painful, MRI.
Thanks for question.

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