This instrument facilitates evidence-based scientific decision-making concerning the administration of cervical backbone accidents. It makes use of a graphical illustration of neurological findings and affected person traits to estimate the chance of spinal wire harm with out radiographic abnormality (SCIWORA). By plotting particular scientific information factors on the nomogram, clinicians acquire a calculated danger share that guides additional investigation and therapy methods. For instance, a affected person presenting with neck ache and neurological signs would have their information factors plotted, offering a danger evaluation based mostly on the nomogram’s established standards.
Its improvement arose from the necessity to handle the challenges of diagnosing SCIWORA, notably in pediatric populations. This diagnostic support empowers clinicians to make knowledgeable selections about imaging, session, and intervention, doubtlessly decreasing pointless radiographic publicity and expediting applicable look after sufferers with suspected cervical backbone accidents. The nomogram gives a standardized and goal framework for danger stratification, contributing to improved affected person outcomes.
Additional exploration of this subject will cowl the nomogram’s particular elements, information interpretation, sensible purposes, and limitations. Discussions will even handle developments in SCIWORA administration and ongoing analysis geared toward refining diagnostic and therapeutic approaches.
1. Threat Stratification
Threat stratification is central to the utility of the Rumack-Matthew Nomogram. This course of permits clinicians to categorize sufferers with potential cervical backbone accidents with out radiographic abnormality (SCIWORA) into totally different danger teams based mostly on scientific findings. This categorization guides selections concerning additional investigation and administration, finally aiming to enhance affected person outcomes.
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Neurological Examination Findings
The nomogram makes use of particular neurological examination findings as key inputs for danger stratification. These findings, together with motor power, sensory deficits, and reflex responses, are plotted on the nomogram to find out the affected person’s danger stage. For example, a affected person exhibiting full paralysis beneath a sure spinal stage could be positioned in a better danger class in comparison with a affected person with solely gentle weak spot.
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Derivation of Threat Proportion
By combining the affected person’s neurological findings on the nomogram, a corresponding danger share for SCIWORA is generated. This share represents the probability of the affected person having SCIWORA regardless of the absence of seen abnormalities on customary radiographs. This goal measure gives a vital basis for subsequent scientific selections.
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Guiding Imaging and Intervention
The chance stratification derived from the nomogram immediately informs the necessity for additional imaging research, resembling MRI or CT scans, and the urgency of neurosurgical session. A better danger share could immediate rapid superior imaging and specialist referral, whereas a decrease danger share may enable for a extra conservative strategy with remark and repeat scientific assessments.
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Influence on Affected person Administration
By facilitating early and correct danger stratification, the nomogram assists clinicians in tailoring administration methods to particular person affected person wants. This could result in extra environment friendly use of assets, diminished publicity to pointless radiation, and doubtlessly improved neurological outcomes by making certain well timed interventions for these at highest danger.
The nomogram’s capability to successfully stratify danger based mostly on goal scientific findings considerably contributes to its worth within the analysis and administration of potential SCIWORA instances. It gives a structured framework for decision-making, enhancing the standard and security of affected person care on this complicated scientific situation.
2. Neurological Evaluation
Neurological evaluation varieties the cornerstone of using the Rumack-Matthew Nomogram Calculator successfully. Correct and complete neurological examination findings present the essential enter information required for the nomogram to generate a sound danger evaluation for spinal wire harm with out radiographic abnormality (SCIWORA). The evaluation’s precision immediately impacts the reliability of the calculated danger and subsequent scientific selections.
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Motor Operate Analysis
Evaluation of motor perform includes evaluating muscle power in key muscle teams related to the cervical backbone. This sometimes consists of assessing higher and decrease extremity power towards resistance, grading the power on a standardized scale (e.g., 0-5 Medical Analysis Council scale). Figuring out particular patterns of weak spot, resembling unilateral versus bilateral deficits, or various levels of weak spot throughout totally different muscle teams, gives essential data for plotting on the nomogram and influencing the calculated SCIWORA danger. For example, a affected person exhibiting full paralysis of the decrease extremities would rating otherwise on the nomogram in comparison with a affected person demonstrating solely gentle weak spot in a single arm.
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Sensory Examination
Sensory examination assesses the affected person’s capability to understand varied sensory modalities, together with mild contact, pinprick, and proprioception. Mapping areas of sensory loss or alteration helps decide the extent and stage of potential spinal wire involvement. The presence and distribution of sensory deficits are vital information factors for the nomogram calculation, contributing to a extra correct danger stratification. A affected person experiencing an entire lack of sensation beneath a selected dermatome would have a distinct danger profile than a affected person with patchy sensory loss.
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Reflex Testing
Reflex testing examines deep tendon reflexes, resembling biceps, triceps, brachioradialis, patellar, and Achilles reflexes. Alterations in reflex responses, together with hyperreflexia, hyporeflexia, or asymmetry, can point out spinal wire dysfunction. These findings are important inputs for the nomogram, additional refining the chance evaluation. Diminished or absent reflexes within the decrease extremities, for instance, would contribute otherwise to the calculated danger in comparison with exaggerated reflexes.
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Serial Assessments
Repeated neurological assessments over time are essential, notably in instances the place preliminary radiographic findings are unfavourable however scientific suspicion for SCIWORA stays. Monitoring for any adjustments in neurological standing, resembling worsening motor weak spot or creating sensory deficits, permits for dynamic danger reassessment utilizing the nomogram. This ongoing analysis helps determine sufferers whose danger could also be evolving, prompting additional investigations or interventions even within the absence of preliminary radiographic proof of harm. For instance, a affected person with initially gentle weak spot who develops progressive paralysis over a number of hours would necessitate re-evaluation utilizing the nomogram and doubtlessly extra aggressive administration.
The comprehensiveness and accuracy of the neurological evaluation immediately affect the reliability of the Rumack-Matthew Nomogram Calculator’s danger prediction. This meticulous evaluation, encompassing motor, sensory, and reflex examinations, gives the muse for knowledgeable scientific decision-making in suspected SCIWORA instances, finally aiming to optimize affected person outcomes.
3. Graphical Interpretation
Graphical interpretation is prime to using the Rumack-Matthew Nomogram successfully. This nomogram, a two-dimensional graphical instrument, gives a visible illustration of the chance of spinal wire harm with out radiographic abnormality (SCIWORA) based mostly on a affected person’s neurological examination findings. Understanding its graphical elements is crucial for correct danger evaluation and subsequent scientific decision-making.
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Plotting Neurological Findings
The nomogram’s x-axis represents the affected person’s age, whereas the y-axis corresponds to particular neurological findings, categorized into totally different zones reflecting growing severity. These findings, sometimes together with motor power, sensory deficits, and reflex responses, are plotted onto the graph. For example, a affected person with weak finger abduction could be plotted in a decrease danger zone in comparison with a affected person experiencing full paralysis of the decrease extremities.
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Figuring out Threat Zones
The nomogram is split into distinct danger zones, typically color-coded for visible readability. These zones signify totally different ranges of SCIWORA danger, starting from low to excessive. The plotted neurological findings fall inside certainly one of these zones, indicating the affected person’s corresponding danger stage. The boundaries of those zones are decided based mostly on the unique analysis information used to develop the nomogram.
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Decoding Threat Percentages
As soon as the affected person’s neurological findings are plotted, the corresponding danger share for SCIWORA might be decided visually by observing the chance zone wherein the plotted level falls. Every zone is related to a selected danger vary, enabling clinicians to quantify the chance objectively. This share helps information selections concerning additional investigation and administration. A affected person falling inside a high-risk zone, for instance, would necessitate extra rapid and aggressive administration in comparison with a affected person in a low-risk zone.
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Contemplating Age-Associated Variations
The nomogram accounts for age-related variations in SCIWORA danger, reflecting the upper prevalence in youthful youngsters. The graphical illustration incorporates this age dependency, making certain extra correct danger evaluation based mostly on the affected person’s developmental stage. The identical neurological findings may place a youthful baby in a better danger zone in comparison with an older adolescent, reflecting the age-specific vulnerabilities in SCIWORA.
Proficient graphical interpretation of the Rumack-Matthew Nomogram permits clinicians to translate neurological evaluation information into an goal SCIWORA danger evaluation. This understanding is essential for evidence-based decision-making, guiding applicable imaging, session, and intervention methods, and finally optimizing affected person care and outcomes in suspected SCIWORA instances. Correct plotting and zone identification inside the nomogram are vital for dependable danger dedication and subsequent scientific administration.
4. SCIWORA Detection
SCIWORA, or spinal wire harm with out radiographic abnormality, presents a major diagnostic problem. Its detection hinges on thorough scientific analysis and danger stratification, aided considerably by instruments just like the Rumack-Matthew Nomogram. This nomogram assists clinicians in figuring out sufferers in danger for SCIWORA regardless of regular preliminary radiographic findings, facilitating well timed intervention and doubtlessly enhancing neurological outcomes.
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Medical Suspicion and Neurological Examination
Excessive scientific suspicion based mostly on the mechanism of harm and presenting signs is paramount. A complete neurological examination, specializing in motor power, sensory perform, and reflexes, gives the essential information required for using the Rumack-Matthew Nomogram. For example, a toddler concerned in a high-speed motorcar collision presenting with transient neurological signs warrants cautious analysis even with regular preliminary X-rays. The nomogram helps quantify the chance of SCIWORA based mostly on these scientific findings, guiding additional investigation.
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Threat Stratification utilizing the Nomogram
The Rumack-Matthew Nomogram facilitates goal danger stratification by plotting the affected person’s age and neurological findings onto a graphical illustration. This generates a calculated danger share for SCIWORA. This danger stratification aids in decision-making concerning superior imaging, resembling MRI, which is crucial for confirming the analysis in suspected SCIWORA instances. A affected person falling inside a high-risk zone on the nomogram necessitates pressing MRI analysis, even when preliminary X-rays are regular.
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Early Detection and Intervention
Early detection of SCIWORA is essential for optimizing neurological outcomes. The nomogram, by enabling early danger stratification, facilitates immediate intervention, together with immobilization, neurosurgical session, and applicable administration methods. This well timed intervention can reduce secondary harm to the spinal wire and doubtlessly enhance long-term useful restoration. A affected person recognized as high-risk by the nomogram may obtain rapid spinal immobilization and neurosurgical referral, doubtlessly mitigating the implications of the harm.
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Limitations and Concerns
Whereas the Rumack-Matthew Nomogram is a precious instrument, it has limitations. It primarily focuses on pediatric sufferers and may not be relevant to adults. Moreover, the nomogram depends on correct and complete neurological examinations. Medical judgment stays important in deciphering the nomogram’s outcomes and making individualized administration selections. Different elements, such because the presence of distracting accidents or pre-existing neurological circumstances, must also be thought of. In some instances, regardless of a low danger based mostly on the nomogram, scientific suspicion should still warrant additional investigation.
The Rumack-Matthew Nomogram considerably contributes to SCIWORA detection by offering a structured framework for danger evaluation based mostly on scientific findings. This instrument, mixed with a excessive index of suspicion and thorough neurological analysis, permits early identification and intervention, finally aiming to enhance outcomes for sufferers with this difficult situation. Nonetheless, recognizing the nomogram’s limitations and the significance of individualized scientific judgment is essential for its efficient software.
5. Proof-Based mostly Choices
Proof-based decision-making is paramount in medication, notably when coping with complicated circumstances like potential spinal wire harm with out radiographic abnormality (SCIWORA). The Rumack-Matthew Nomogram Calculator performs a vital position in facilitating such selections by offering a structured framework for assessing and managing these instances based mostly on established scientific information and analysis.
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Goal Threat Evaluation
The nomogram interprets subjective scientific findings into an goal danger share for SCIWORA. This quantifiable danger evaluation replaces reliance on anecdotal expertise or instinct, enabling clinicians to make extra knowledgeable selections concerning additional investigation and administration. For example, fairly than relying solely on scientific gestalt, the nomogram gives a concrete danger share to information selections about ordering superior imaging or consulting with a specialist. This objectivity enhances the reliability and consistency of scientific selections throughout totally different practitioners and healthcare settings.
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Standardized Method to Administration
The nomogram promotes a standardized strategy to managing potential SCIWORA instances. By offering clear danger stratification based mostly on neurological findings, it guides selections about immobilization, imaging, and session, decreasing variations in follow and selling adherence to evidence-based tips. This standardized strategy ensures that sufferers obtain constant and applicable care, whatever the particular clinician or establishment concerned. This consistency is especially essential in time-sensitive conditions the place fast and standardized decision-making can considerably affect affected person outcomes.
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Decreased Pointless Interventions
By objectively figuring out low-risk sufferers, the nomogram might help cut back pointless interventions, resembling extended immobilization or pointless superior imaging. This not solely minimizes affected person discomfort and potential issues but in addition optimizes useful resource allocation and reduces healthcare prices. For instance, a affected person deemed low-risk by the nomogram may keep away from pointless MRI scans, decreasing publicity to radiation and the related prices and anxieties. This even handed use of assets permits for extra environment friendly and focused healthcare supply.
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Improved Affected person Outcomes
In the end, the usage of the Rumack-Matthew Nomogram in evidence-based decision-making goals to enhance affected person outcomes. By facilitating early and correct danger stratification, it permits well timed and applicable interventions for these at highest danger, doubtlessly minimizing long-term neurological deficits. This proactive strategy to administration, guided by evidence-based danger evaluation, can result in improved useful restoration and general high quality of life for sufferers with SCIWORA.
The Rumack-Matthew Nomogram Calculator considerably contributes to evidence-based decision-making within the analysis and administration of potential SCIWORA. By offering an goal, standardized, and environment friendly strategy to danger evaluation, it empowers clinicians to make knowledgeable selections that optimize affected person care and finally enhance neurological outcomes. Its position in decreasing pointless interventions whereas making certain well timed and applicable administration for high-risk sufferers underscores its worth in trendy scientific follow.
6. Pediatric Utility
The Rumack-Matthew Nomogram Calculator finds outstanding software in pediatric populations, notably as a result of larger incidence of spinal wire harm with out radiographic abnormality (SCIWORA) in youngsters. This particular software stems from the distinctive challenges of diagnosing SCIWORA in youthful sufferers, the place scientific shows might be refined and radiological findings could also be initially unfavourable. The nomogram’s utility lies in its capability to offer an goal danger evaluation based mostly on neurological examination findings, aiding clinicians in making knowledgeable selections concerning additional investigation and administration on this weak inhabitants.
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Developmental Anatomy and SCIWORA
Youngsters’s creating spinal anatomy, characterised by larger ligamentous laxity and incomplete ossification, contributes to their elevated susceptibility to SCIWORA. The nomogram considers these age-related anatomical variations, offering a extra correct danger evaluation in comparison with relying solely on adult-based standards. For example, a toddler with gentle neurological deficits could be categorized as larger danger on the nomogram in comparison with an grownup with related findings, reflecting the kid’s larger vulnerability to SCIWORA. This age-specific danger stratification is essential for guiding applicable administration methods.
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Challenges in Pediatric Neurological Evaluation
Assessing neurological perform in youngsters might be difficult on account of communication obstacles, restricted cooperation, and the evolving nature of their neurological improvement. The nomogram gives a structured framework for deciphering neurological findings on this context, aiding clinicians in distinguishing transient signs from true SCIWORA. For instance, a younger baby unable to articulate sensory deficits may nonetheless exhibit irregular motor responses that, when plotted on the nomogram, contribute to a extra correct danger evaluation.
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Lowering Radiation Publicity
Minimizing radiation publicity is a paramount concern in pediatric healthcare. The nomogram, by facilitating early and goal danger stratification, might help cut back the necessity for pointless imaging research, resembling CT scans, in low-risk sufferers. This selective strategy to imaging not solely reduces radiation publicity but in addition optimizes useful resource utilization and minimizes affected person discomfort. A toddler deemed low-risk based mostly on the nomogram may endure remark and repeat neurological examinations as a substitute of rapid CT imaging, avoiding potential radiation-related dangers.
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Guiding Neurosurgical Session
The nomogram assists in figuring out the necessity for neurosurgical session in suspected SCIWORA instances. By offering a quantifiable danger evaluation, it helps determine sufferers who require specialist analysis and potential intervention, making certain well timed entry to specialised care. A toddler with high-risk findings on the nomogram would immediate rapid neurosurgical session, facilitating early intervention and doubtlessly enhancing neurological outcomes. This streamlined referral course of optimizes useful resource allocation and ensures that high-risk sufferers obtain immediate and specialised consideration.
The Rumack-Matthew Nomogram Calculator affords a precious instrument for enhancing the administration of potential SCIWORA in pediatric sufferers. By addressing the distinctive challenges related to this inhabitants, together with developmental anatomy, evaluation difficulties, and radiation issues, the nomogram empowers clinicians to make evidence-based selections, optimize useful resource utilization, and finally attempt for improved neurological outcomes in these weak younger sufferers. Its software underscores the significance of age-specific issues within the analysis and administration of spinal wire accidents.
Regularly Requested Questions
This part addresses frequent queries concerning the applying and interpretation of the Rumack-Matthew Nomogram in evaluating potential spinal wire accidents with out radiographic abnormality (SCIWORA).
Query 1: What particular neurological findings are used within the Rumack-Matthew Nomogram?
The nomogram incorporates findings resembling motor power, sensory deficits, and reflex responses, every contributing to the general danger evaluation.
Query 2: How does the nomogram account for age-related variations in SCIWORA danger?
The nomogram’s graphical illustration incorporates age as a key variable, reflecting the upper prevalence and differing anatomical issues in youthful sufferers.
Query 3: Can the nomogram be utilized to grownup sufferers with suspected SCIWORA?
The nomogram’s main validation and software are inside the pediatric inhabitants. Its applicability to adults is restricted and requires cautious scientific judgment.
Query 4: Does a traditional consequence on the nomogram assure the absence of SCIWORA?
Whereas a low-risk consequence on the nomogram is reassuring, it doesn’t definitively exclude the opportunity of SCIWORA. Medical suspicion and additional investigation should still be warranted based mostly on particular person affected person circumstances.
Query 5: What are the constraints of the Rumack-Matthew Nomogram?
Limitations embody its main applicability to pediatric sufferers, reliance on correct neurological examinations, and the potential affect of different confounding elements, resembling distracting accidents. Medical judgment stays important.
Query 6: How does the nomogram contribute to evidence-based decision-making in SCIWORA?
The nomogram facilitates evidence-based selections by offering an goal danger evaluation that guides additional investigations, resembling MRI, and determines the necessity for specialist consultations, making certain applicable useful resource utilization and well timed interventions.
Understanding these key features of the Rumack-Matthew Nomogram permits for its applicable and efficient software in evaluating potential SCIWORA instances, contributing to improved diagnostic accuracy and affected person administration.
The following part will delve into case research illustrating sensible purposes and interpretations of the Rumack-Matthew Nomogram in varied scientific situations.
Ideas for Using the Rumack-Matthew Nomogram
The following pointers supply sensible steering for clinicians using the nomogram to evaluate potential spinal wire harm with out radiographic abnormality (SCIWORA), emphasizing correct software and interpretation.
Tip 1: Thorough Neurological Examination is Essential
A complete neurological evaluation varieties the muse for correct nomogram software. Meticulous analysis of motor power, sensory perform, and reflexes is crucial for acquiring dependable information for plotting on the nomogram and making certain a sound danger evaluation. Overlooking refined neurological deficits can result in inaccurate danger stratification.
Tip 2: Take into account Age-Associated Variations
Pediatric sufferers exhibit a better incidence of SCIWORA on account of developmental variations in spinal anatomy. All the time take into account the affected person’s age when deciphering nomogram outcomes, recognizing that youthful youngsters could also be at larger danger even with seemingly gentle neurological findings.
Tip 3: Correct Plotting is Important
Exact plotting of neurological findings on the nomogram is essential for acquiring a sound danger share. Double-check plotted factors to reduce errors and guarantee correct danger zone identification. Inaccurate plotting can result in misinterpretation and doubtlessly inappropriate administration selections.
Tip 4: Interpret Threat Zones Rigorously
Perceive the totally different danger zones depicted on the nomogram and their corresponding danger percentages. Acknowledge that the boundaries between zones signify important shifts in danger ranges and warrant cautious consideration when making administration selections. Misinterpreting danger zones can result in both overtreatment or undertreatment.
Tip 5: Serial Neurological Assessments are Key
SCIWORA can evolve over time, and repeated neurological assessments are essential for monitoring any adjustments within the affected person’s situation. Reassess and replot on the nomogram as wanted, notably if scientific suspicion stays excessive regardless of preliminary unfavourable findings. Failing to carry out serial assessments can delay analysis and intervention.
Tip 6: Combine Medical Judgment
Whereas the nomogram gives an goal danger evaluation, scientific judgment stays paramount. Take into account the whole scientific image, together with mechanism of harm, related accidents, and different particular person affected person elements when making administration selections. Relying solely on the nomogram with out contemplating different scientific variables can result in suboptimal care.
Tip 7: Seek the advice of with Specialists When Obligatory
Excessive-risk sufferers recognized by the nomogram warrant immediate neurosurgical session. Don’t hesitate to hunt skilled opinion in instances of diagnostic uncertainty or complicated scientific shows. Delayed session can compromise outcomes in high-risk SCIWORA instances.
By adhering to those suggestions, clinicians can make the most of the Rumack-Matthew Nomogram successfully, maximizing its diagnostic worth and contributing to improved outcomes for sufferers with potential SCIWORA. Correct software and interpretation of the nomogram, coupled with sound scientific judgment, are essential for evidence-based administration of this difficult situation.
The next conclusion summarizes the important thing takeaways concerning the importance and applicable utilization of the Rumack-Matthew Nomogram in scientific follow.
Conclusion
This exploration of the Rumack-Matthew Nomogram Calculator has highlighted its significance as a scientific decision-making instrument in evaluating potential spinal wire harm with out radiographic abnormality (SCIWORA), notably in pediatric populations. Key features mentioned embody the nomogram’s position in danger stratification based mostly on neurological findings, its graphical interpretation, its contribution to evidence-based administration, and its utility in decreasing pointless interventions whereas facilitating well timed specialist consultations. Limitations and caveats concerning the nomogram’s software, resembling its main concentrate on pediatric sufferers and the important position of scientific judgment, have been additionally emphasised. Understanding these elements is essential for applicable and efficient nomogram utilization.
The Rumack-Matthew Nomogram Calculator stays a precious useful resource for clinicians managing potential SCIWORA instances. Continued emphasis on correct neurological evaluation, cautious interpretation of danger stratification, and integration of scientific judgment will additional improve the nomogram’s effectiveness in selling optimum affected person outcomes. Ongoing analysis and scientific expertise will undoubtedly refine understanding of SCIWORA and additional improve diagnostic and administration methods on this difficult scientific space.
