Double-level spinal cord injury without vertebral fracture or dislocation: A case report

Spinal cord injuries without evidence of vertebral fracture or dislocation on plain radiographs and computed tomography are referred to as SCIWORA (Spinal Cord Injury without Radiological Abnormality). This entity is seen more often in children due to the specific anatomical and functional properties of the pediatric spine. The aim of this study was to present a rare case in which SCIWORA occurred at two levels simultaneously with complete anatomic transection and to emphasize the importance of SCIWORA in forensic medicine. A three-year-old boy was admitted to the emergency department with paraplegia after being hit by a car. Computed tomography and plain radiographs failed to reveal any bone fracture or dislocation. However, magnetic resonance imaging showed loss of continuity with near-complete and complete anatomic transection of the spinal cord at the T3-4 and T6-7 levels. According to the literature, only two cases of double-level SCIWORA have been reported previously. However, this is the first case of double-level SCIWORA with complete anatomic transection. The mechanism of injury in the case reported here remains obscure regarding the forensic reconstruction of the event.