We congratulate Liu et al.1 on their series of 54 adult patients with spinal cord injury without radiologic abnormalities (SCIWORA) who underwent magnetic resonance imaging (MRI), which has been recently published in your esteemed journal. The diagnostic approach is well defined, MRI findings were grouped according to previously described imaging patterns and all the patients were followed up 6 months after discharge.
Interestingly, the author’s central conclusion that the findings of early MRI in SCIWORA do not correlate with the neurological outcome does contradict the majority of the previously published literature on SCIWORA in adults2 and children.3
Considering the rarity of SCIWORA, the statistical interpretation of the findings observed in single-center cohorts and their generalizability are substantially limited. Thus, only the detailed description of case-specific clinical and imaging findings enables precise data pooling and reliable meta-analysis of the published cumulative population with SCIWORA.
We are convinced that both, the inclusion of precisely classified early MRI findings as well as the presentation of the American Spinal Injury Association Impairment Scale grades at admission, discharge and final follow-up on individual level should be the minimum standard for future reports on SCIWORA.
Taken together, we encourage the publication of further single-center cohorts of patients with SCIWORA, provided that neurologic and imaging findings can be reliably interpreted and compared during subsequent pooled analysis.
References
Liu Q, Liu Q, Zhao J, Yu H, Ma X, Wang L . Early MRI finding in adult spinal cord injury without radiologic abnormalities does not correlate with the neurological outcome: a retrospective study. Spinal Cord (e-pub ahead of print 17 March 2015; doi:10.1038/sc.2015.45.
Boese CK, Lechler P . Spinal cord injury without radiologic abnormalities in adults: a systematic review. J Trauma Acute Care Surg 2013; 75: 320–330.
Boese CK, Oppermann J, Siewe J, Eysel P, Scheyrer MJ, Lechler P . Spinal cord injury without radiologic abnormality in children: A systematic review and meta-analysis. J Trauma Acute Care Surg 2015; 78: 874–882.
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Boese, C., Lechler, P. Early MRI finding in adult spinal cord injury without radiologic abnormalities does not correlate with the neurological outcome: a retrospective study. Spinal Cord 53, 778 (2015). https://doi.org/10.1038/sc.2015.79
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DOI: https://doi.org/10.1038/sc.2015.79