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Sports Medicine Clinic

Sports Medicine Clinic. Physician. Sports Coverage. Wrestling Tournament. Stop due to neck pain. Neck Pain. Over the next 4 days. Weak More Fatigue. What is the Dx ?. SCIWORA. What does it stand for?. History.

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Sports Medicine Clinic

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  1. Sports Medicine Clinic Physician

  2. Sports Coverage

  3. Wrestling Tournament • Stop due to neck pain

  4. Neck Pain

  5. Over the next 4 days • Weak • More Fatigue

  6. What is the Dx?

  7. SCIWORA What does it stand for?

  8. History 1969 : mentioned in medical literature as a unique syndrome in study of 29 children with traumatic paraplegia where 16 had no x-ray findings, done at NSIC Aylesbury, Buckinghamshire, England.

  9. History • 1982 : First coined by Pang and Wilberger, defined the term SCIWORA as "objective signs of myelopathy as a result of trauma" with no evidence of fracture or ligamentous instability on plain spine radiographs and tomography.

  10. What is the Incidence of SCIWORA ?

  11. Incidence of SCIWORA • 0-5 64% • 6-12 32% • 13-15 22% • 16-21 19% • <12 49% • 13-21 20%

  12. Why?

  13. Why ?

  14. What should be done next?

  15. SCIWORA • MRI should be done • 65 % abnormal • Delayed neurological

  16. MRI abnormalities - neural • Complete cord disruption • Cord hemorrhage • Cord edema

  17. MRI – extra-neural abnormalities • Rupture of the anterior and posterior longitudinal ligaments

  18. Prognoses • Severely of MRI Changes

  19. Why the neurological delay ?

  20. Delay due to…. • 30 minutes to 4 days • 25% of children with SCI • Natural expansion of cord by inflammation • Post-traumatic occlusion of radicular arteries secondary to thrombosis or spasm with delayed infarction of spinal cord • Repeat trauma to cord after initial injury

  21. What are the AIS Grades ?

  22. Neurological presentation: • •wide spectrum of neurological dysfunction, ranging from mild, transient spinal cord concussive deficits to permanent, complete injuries of the spinal cord, incidence and severity are related to the patient's age. • • • Young children have a higher incidence of SCIWORA • • • Transient neurological deficit (i.e. paraparesis or quadriparesis), or persisting subjective symptoms (i.e. numbness or dysesthesias) would be a candidate for the diagnosis of SCIWORA. • •Pang and Wilberger described 13 of their 24 children to have a "latent" period from 30 minutes to four days (mean 1.2 days) before the onset of objective sensorimotor deficits

  23. Complications Spine deformity Hip subluxation/dislocation Less 8 years old 62% > 9 years old 10% • 98% prevalence • 67% need for surgery

  24. TreatmentSpine is immobilized for one to three weeks

  25. Are they going to succeed?

  26. Teamwork to Succeed

  27. What is this ??

  28. Detroit 1-8-7 Wrestling New TV Show

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