Diagnosis, management and outcome of Spinal Cord Injury without Radiographic Abnormalities (SCIWORA) in adult patients with trauma: a case series.

BACKGROUND: Spinal cord injury without radiographic abnormality (SCIWORA) in adults causes diagnostic and prognostic dilemma as radiography and/or computed tomography does not clearly detect bone lesions during the initial assessment. Herein, we report our experience on 11 spinal cord injury cases without radiographic abnormality, regarding the clinicoradiological features, management, and outcomes. METHODS: We conducted a case series of adult patients with SCIWORA who were admitted at the level 1 trauma center at Hamad General Hospital from January 2008 to July 2018. All patients underwent initial head and spine X-ray imaging, computed tomography, magnetic resonance imaging, and 12 months of clinical follow-up. RESULTS: Eleven patients (mean age, 46.5 ± 14.4 years) met the criteria of SCIWORA. The neurologic status on admission and 12 months after hospital discharge were classified according to the American Spinal Injury Association (ASIA) impairment scale (AIS). On admission, 6 (54.5%) patients had ASIA grade C: 2 (18.2%) each had AIS grade D and B and 1 (9.1%) had AIS grade A. Five cases were treated conservatively with rehabilitation and physiotherapy, and five were treated surgically by anterior cervical discectomy with fusion. One patient who declined surgery was managed with a sternal occipital mandibular immobilizer brace and underwent rehabilitation. CONCLUSION: SCIWORA requires higher clinical suspicion and thorough neurological and radiologic assessment to prevent secondary spinal cord injuries and complications.

Chest Tube Insertion in Prone Position Using Ultrasound in a COVID 19 Patient.

Chest tube insertion is one of the most common interventions performed to manage pleural effusion, pneumothorax, haemothorax, etc. The procedure is done conventionally in a supine position, and a triangle of safety is used as a landmark. COVID-19 is a multiorgan disorder, declared a pandemic by WHO, predominantly involving the respiratory system. To insert a chest tube in a prone position using the Seldinger technique is quite a unique way of doing this common procedure with unclear complications in literature. COVID-19 is a highly infectious disease that makes chest tube insertion a risky procedure for operators as well due to direct exposure to respiratory secretions. Full personal protective equipment and a negative pressure room are used during this procedure in this case. The case mentions the ultrasound-guided chest tube insertion in a COVID-19 patient with severe acute respiratory distress syndrome (ARDS) and significant left-sided pleural effusion requiring prone positioning and mechanical ventilation.