Spinal Cord Injury without Radiographic Abnormality

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Abstract
Standards There is insufficient evidence to support diagnostic standards. Guidelines There is insufficient evidence to support diagnostic guidelines. Options Plain spinal x-rays of the region of injury and computed tomographic scanning with attention to the suspected level of neurological injury to exclude occult fractures are recommended. Magnetic resonance imaging of the region of suspected neurological injury may provide useful diagnostic information. Plain x-rays of the entire spinal column may be considered. Neither spinal angiography nor myelography is recommended in the evaluation of patients with spinal cord injury without radiographic abnormality. Standards There is insufficient evidence to support treatment standards. Guidelines There is insufficient evidence to support treatment guidelines. Options External immobilization is recommended until spinal stability is confirmed by flexion/extension x-rays. External immobilization of the spinal segment of injury for up to 12 weeks may be considered. Avoidance of “high-risk” activities for up to 6 months after spinal cord injury without radiographic abnormality may be considered. Standards There is insufficient evidence to support prognostic standards. Guidelines There is insufficient evidence to support prognostic guidelines. Options Magnetic resonance imaging of the region of neurological injury may provide useful prognostic information about neurological outcome after spinal cord injury without radiographic abnormality.