Medscape is available in 5 Language Editions – Choose your Edition here.


Spinal Cord Injuries Workup

  • Author: Lawrence S Chin, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
Updated: May 12, 2016

Approach Considerations

With regard to laboratory studies, the following may be helpful:

  • Arterial blood gas (ABG) measurements may be useful to evaluate adequacy of oxygenation and ventilation
  • Lactate levels to monitor perfusion status can be helpful in the presence of shock
  • Hemoglobin and/or hematocrit levels may be measured initially and monitored serially to detect or monitor sources of blood loss
  • Urinalysis can be performed to detect any associated genitourinary injury

Diagnostic imaging traditionally begins with the acquisition of standard radiographs of the affected region of the spine. Investigators have shown that computed tomography (CT) scanning is exquisitely sensitive for the detection of spinal fractures and is cost effective.[34, 35] In many centers, CT scanning has supplanted plain radiographs.

A properly performed lateral radiograph of the cervical spine that includes the C7-T1 junction can provide sufficient information to allow the multiple trauma victim to proceed emergently to the operating room if necessary without additional intervention other than maintenance of full spinal immobilization and a hard cervical collar.

Noncontiguous spinal fractures are defined as spinal fractures separated by at least 1 normal vertebra. Noncontiguous fractures are common and occur in 10-15% of patients with spinal cord injury. Therefore, once a spinal fracture is identified, the entire axial skeleton must be imaged, preferably by CT scanning, to assess for noncontiguous fractures.[31, 36, 37]


Plain Radiography

In many emergency departments (EDs), radiology support is limited. If unsure of a finding, request a formal interpretation or immobilize the patient appropriately, pending formal review of the studies.

In addition, note that the failure to adequately immobilize the spine when the mechanism of injury is consistent with the diagnosis is a pitfall.

Agitated, intoxicated patients are often the most difficult to manage properly. Pharmacologic restraint may be required to allow proper assessment. Haldol and intravenous (IV) droperidol have been used successfully, even in large doses, without hemodynamic or respiratory compromise. Occasionally, rapid-sequence intubation and pharmacologic paralysis is required to manage these patients.

Physical examination and radiographic studies could be delayed until the patient is more cooperative, if his or her overall condition permits.

Radiographic views

Radiographs are only as good as the first and last vertebrae seen, therefore, radiographs must adequately depict all vertebrae. A common cause of missed injury is the failure to obtain adequate images (eg, cervical spine radiograph that incompletely depicts the C7-T1 junction). However, be aware that radiography is insensitive to small fractures of the vertebra.

Published clinical criteria have established guidelines for cervical spine radiography in symptomatic trauma patients with neck pain. The NEXUS (National Emergency X-Radiography Utilization Study) criteria and the Canadian C-spine rules were validated in large clinical trials.[38, 39, 40] These algorithms may be used to guide physicians to determine whether or not imaging of the cervical spine is required.[38, 39, 40]

The standard 3 views of the cervical spine are recommended in patients with suspected spinal cord injury (SCI): anteroposterior (AP), lateral, and odontoid.

The cervical spine radiographs must include the C7-T1 junction to be considered adequate. Subtle findings (eg, increased prevertebral soft tissue swelling or widening of the C1-C2 preodontoid space) indicate potentially unstable cervical spine injuries that could have serious consequences if they are not detected.

Dynamic flexion/extension views are safe and effective for detecting occult ligamentous injury of the cervical spine in the absence of fracture. The negative predictive value of a normal 3-view cervical spine series and flexion/extension views exceeds 99%. The incidence of occult injury in the setting of normal findings on cervical spine radiography and CT scanning is low, so clinical judgment and the mechanism of injury should be used to guide the decision to order flexion/extension views.

Anteroposterior and lateral views of the thoracic and lumbar spine are recommended for suspected injuries to the thoracolumbar spine.

Adequate spinal radiography supplemented by computed tomography (CT) scanning through areas that are difficult to visualize or are suspicious detects the vast majority of fractures with a reported negative predictive value between 99% and 100%.[34]


Computed Tomography Scanning

Computed tomography (CT) scanning is reserved for delineating bony abnormalities or fracture. Some studies have suggested that CT scanning with sagittal and coronal reformatting is more sensitive than plain radiography for the detection of spinal fractures.[34, 41]

Perform CT scanning in the following situations:

  • When plain radiography is inadequate or fails to visualize segments of the axial skeleton
  • Convenience and speed: If a CT scan of the head is required, then it is usually simpler and faster to obtain a CT of the cervical spine at the same time. Similarly, CT images of the thoracic or lumbar spine might be easier and faster to obtain than plain radiographs.
  • To provide further evaluation when radiography depicts suspicious and/or indeterminate abnormalities
  • When radiography depicts fracture or displacement, CT scanning provides better visualization of the extent and displacement of the fracture

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is best for suspected spinal cord lesions, ligamentous injuries, or other soft-tissue injuries or pathology. This imaging modality should be used to evaluate nonosseous lesions, such as extradural spinal hematoma; abscess or tumor; disk rupture; and spinal cord hemorrhage, contusion, and/or edema.

Neurologic deterioration is usually caused by secondary injury, resulting in edema and/or hemorrhage. MRI is the best diagnostic image to depict these changes.

Contributor Information and Disclosures

Lawrence S Chin, MD, FACS Robert B and Molly G King Endowed Professor and Chair, Department of Neurosurgery, State University of New York Upstate Medical University

Lawrence S Chin, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association for Cancer Research, Children's Oncology Group, Society for Neuro-Oncology, Congress of Neurological Surgeons, American Association of Neurological Surgeons, American College of Surgeons, Phi Beta Kappa

Disclosure: Nothing to disclose.


Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM Attending Interventional Physiatrist, Wellspan Health

Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM is a member of the following medical societies: American College of Sports Medicine, American Academy of Physical Medicine and Rehabilitation, Royal College of Surgeons of England, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Medical Informatics Association, Association of Academic Physiatrists, International Society of Physical and Rehabilitation Medicine

Disclosure: Nothing to disclose.

Fassil B Mesfin, MD, PhD Assistant Professor of Neurosurgery, Director of Complex Spine and Spine Oncology Program, University of Missouri-Columbia School of Medicine

Fassil B Mesfin, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Association of Neurological Surgeons, American Medical Association, National Medical Association, Congress of Neurological Surgeons, American Academy of Neurological Surgery

Disclosure: Nothing to disclose.

Chief Editor

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, International Parkinson and Movement Disorder Society, Congress of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from St Jude Neuromodulation for consulting; Received consulting fee from MRI Interventions for consulting.


Denise I Campagnolo, MD, MS Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers

Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers

Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching; Genzyme Corporation Grant/research funds investigator; Biogen Idec Grant/research funds investigator; Genentech, Inc Grant/research funds investigator; Eli Lilly & Company Grant/research funds investigator; Novartis investigator; MSDx LLC Grant/research funds investigator; BioMS Technology Corp Grant/research funds investigator; Avanir Pharmaceuticals Grant/research funds investigator

Daniel J Dire, MD, FACEP, FAAP, FAAEM Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center San Antonio

Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Milton J Klein, DO, MBA Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital and Ohio Valley General Hospital

Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Tom Scaletta, MD Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Donald Schreiber, MD, CM Associate Professor of Surgery (Emergency Medicine), Stanford University School of Medicine

Donald Schreiber, MD, CM is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Abbott Point of Care Inc Research Grant and Speakers Bureau Speaking and teaching; Nanosphere Inc Grant/research funds Research; Singulex Inc Grant/research funds Research; Abbott Diagnostics Inc Grant/research funds None

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

  1. Hand L. FDA OKs device to help people with some spinal injuries walk. Medscape Medical News. June 26, 2014. [Full Text].

  2. FDA news release. FDA allows marketing of first wearable, motorized device that helps people with certain spinal cord injuries to walk. US Food and Drug Administration. Available at Accessed: June 29, 2014.

  3. American Spinal Injury Association. International Standards for Neurological Classifications of Spinal Cord Injury. revised ed. Chicago, Ill: American Spinal Injury Association; 2000. 1-23.

  4. Ditunno JF Jr, Young W, Donovan WH, Creasey G. The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia. 1994 Feb. 32(2):70-80. [Medline].

  5. Waters RL, Adkins RH, Yakura JS. Definition of complete spinal cord injury. Paraplegia. 1991 Nov. 29(9):573-81. [Medline].

  6. Wuermser LA, Ho CH, Chiodo AE, Priebe MM, Kirshblum SC, Scelza WM. Spinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury. Arch Phys Med Rehabil. 2007 Mar. 88(3 Suppl 1):S55-61. [Medline].

  7. Congress of Neurologic Surgeons. Blood pressure management after acute spinal cord injury. Neurosurgery. 2002 Mar. 50(3 Suppl):S58-62. [Medline].

  8. Westgren N, Levi R. Quality of life and traumatic spinal cord injury. Arch Phys Med Rehabil. 1998 Nov. 79(11):1433-9. [Medline].

  9. Kriss VM, Kriss TC. SCIWORA (spinal cord injury without radiographic abnormality) in infants and children. Clin Pediatr (Phila). 1996 Mar. 35(3):119-24. [Medline].

  10. Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 2004 Dec. 55(6):1325-42; discussion 1342-3. [Medline].

  11. Yucesoy K, Yuksel KZ. SCIWORA in MRI era. Clin Neurol Neurosurg. 2008 May. 110(5):429-33. [Medline].

  12. Rhee P, Kuncir EJ, Johnson L, Brown C, Velmahos G, Martin M, et al. Cervical spine injury is highly dependent on the mechanism of injury following blunt and penetrating assault. J Trauma. 2006 Nov. 61(5):1166-70. [Medline].

  13. National Spinal Cord Injury Statistical Center (NSCIS). Spinal cord injury facts and figures at a glance. February 2011. [Full Text].

  14. Krause JS, Sternberg M, Lottes S, Maides J. Mortality after spinal cord injury: an 11-year prospective study. Arch Phys Med Rehabil. 1997 Aug. 78(8):815-21. [Medline].

  15. DeVivo MJ. Epidemiology of traumatic spinal cord injury. Kirshblum S, Campagnolo DI, DeLisa JA, eds. Spinal Cord Medicine. Baltimore, Md: Lippincott Williams & Wilkins; 2002. 69-81.

  16. Go BK, DeVivo MJ, Richards JS. The epidemiology of spinal cord injury. Stover SL, DeLisa JA, Whiteneck GG, eds. Spinal Cord Injury. Gaithersburg, Md: Aspen; 1995. 21-55.

  17. Avery JD, Avery JA. Malignant spinal cord compression: a hospice emergency. Home Healthc Nurse. 2008 Sep. 26(8):457-61; quiz 462-3. [Medline].

  18. Vitale MG, Goss JM, Matsumoto H, Roye DP Jr. Epidemiology of pediatric spinal cord injury in the United States: years 1997 and 2000. J Pediatr Orthop. 2006 Nov-Dec. 26(6):745-9. [Medline].

  19. Krause JS. Years to employment after spinal cord injury. Arch Phys Med Rehabil. 2003 Sep. 84(9):1282-9. [Medline].

  20. Morse LR, Stolzmann K, Nguyen HP, Jain NB, Zayac C, Gagnon DR, et al. Association between mobility mode and C-reactive protein levels in men with chronic spinal cord injury. Arch Phys Med Rehabil. 2008 Apr. 89(4):726-31. [Medline]. [Full Text].

  21. Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus. 2008. 25(5):E13. [Medline].

  22. Turner AP, Bombardier CH, Rimmele CT. A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: implications for treatment matching. Arch Phys Med Rehabil. 2003 Mar. 84(3):358-64. [Medline].

  23. Frisbie JH, Tun CG. Drinking and spinal cord injury. J Am Paraplegia Soc. 1984 Oct. 7(4):71-3. [Medline].

  24. Strauss DJ, Devivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil. 2006 Aug. 87(8):1079-85. [Medline].

  25. Budh CN, Osteråker AL. Life satisfaction in individuals with a spinal cord injury and pain. Clin Rehabil. 2007 Jan. 21(1):89-96. [Medline].

  26. Widerström-Noga E, Biering-Sørensen F, Bryce T, Cardenas DD, Finnerup NB, Jensen MP, et al. The international spinal cord injury pain basic data set. Spinal Cord. 2008 Dec. 46(12):818-23. [Medline].

  27. van Middendorp JJ, Hosman AJ, Donders AR, Pouw MH, Ditunno JF Jr, Curt A, et al. A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet. 2011 Mar 19. 377(9770):1004-10. [Medline].

  28. Wolpaw JR, McFarland DJ. Control of a two-dimensional movement signal by a noninvasive brain-computer interface in humans. Proc Natl Acad Sci U S A. 2004 Dec 21. 101(51):17849-54. [Medline].

  29. Birbaumer N, Ghanayim N, Hinterberger T, Iversen I, Kotchoubey B, Kubler A. A spelling device for the paralysed. Nature. 1999 Mar 25. 398(6725):297-8. [Medline].

  30. Pfurtscheller G, Muller GR, Pfurtscheller J, Gerner HJ, Rupp R. Thought'--control of functional electrical stimulation to restore hand grasp in a patient with tetraplegia. Neurosci Lett. 2003 Nov 6. 351(1):33-6. [Medline].

  31. Harris MB, Sethi RK. The initial assessment and management of the multiple-trauma patient with an associated spine injury. Spine. 2006 May 15. 31(11 Suppl):S9-15; discussion S36. [Medline].

  32. Ho CH, Wuermser LA, Priebe MM, Chiodo AE, Scelza WM, Kirshblum SC. Spinal cord injury medicine. 1. Epidemiology and classification. Arch Phys Med Rehabil. 2007 Mar. 88(3 Suppl 1):S49-54. [Medline].

  33. Claydon VE, Krassioukov AV. Orthostatic hypotension and autonomic pathways after spinal cord injury. J Neurotrauma. 2006 Dec. 23(12):1713-25. [Medline].

  34. Brown CV, Antevil JL, Sise MJ, Sack DI. Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: its time has come. J Trauma. 2005 May. 58(5):890-5; discussion 895-6. [Medline].

  35. Grogan EL, Morris JA Jr, Dittus RS, et al. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan. J Am Coll Surg. 2005 Feb. 200(2):160-5. [Medline].

  36. Keenen TL, Antony J, Benson DR. Non-contiguous spinal fractures. J Trauma. 1990 Apr. 30(4):489-91. [Medline].

  37. Powell JN, Waddell JP, Tucker WS, Transfeldt EE. Multiple-level noncontiguous spinal fractures. J Trauma. 1989 Aug. 29(8):1146-50; discussion 1150-1. [Medline].

  38. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000 Jul 13. 343(2):94-9. [Medline].

  39. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003 Dec 25. 349(26):2510-8. [Medline].

  40. Stiell IG, Wells GA, Vandemheen KL. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17. 286(15):1841-8. [Medline].

  41. Acheson MB, Livingston RR, Richardson ML, Stimac GK. High-resolution CT scanning in the evaluation of cervical spine fractures: comparison with plain film examinations. AJR Am J Roentgenol. 1987 Jun. 148(6):1179-85. [Medline].

  42. Bracken MB, Shepard MJ, Hellenbrand KG, et al. Methylprednisolone and neurological function 1 year after spinal cord injury. Results of the National Acute Spinal Cord Injury Study. J Neurosurg. 1985 Nov. 63(5):704-13. [Medline].

  43. Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA. 1997 May 28. 277(20):1597-604. [Medline].

  44. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2002. CD001046. [Medline].

  45. Nesathurai S. Steroids and spinal cord injury: revisiting the NASCIS 2 and NASCIS 3 trials. J Trauma. 1998 Dec. 45(6):1088-93. [Medline].

  46. Hurlbert RJ, Hamilton MG. Methylprednisolone for acute spinal cord injury: 5-year practice reversal. Can J Neurol Sci. 2008 Mar. 35(1):41-5. [Medline].

  47. Sansam KA. Controversies in the management of traumatic spinal cord injury. Clin Med. 2006 Mar-Apr. 6(2):202-4. [Medline].

  48. Hadley MN, Walters BC, Grabb PA, et al. Pharmacological therapy after acute spinal cord injury. Neurosurgery. 2002. 50 Suppl:63-72.

  49. Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Questionnaire survey of spine surgeons on the use of methylprednisolone for acute spinal cord injury. Spine. 2006 Apr 20. 31(9):E250-3. [Medline].

  50. Anderson P. New CNS/AANS Guidelines Discourage Steroids in Spinal Injury. Medscape Medical News. Mar 28 2013. Available at Accessed: April 7 2013.

  51. Hadley MN, Walters BC. Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries. Neurosurgery. Mar 2013;72(Suppl 2):1-259. Available at Accessed: Apr 9 2013.

  52. Geisler FH, Dorsey FC, Coleman WP. Recovery of motor function after spinal-cord injury--a randomized, placebo-controlled trial with GM-1 ganglioside. N Engl J Med. 1991 Jun 27. 324(26):1829-38. [Medline].

  53. Bagnall AM, Jones L, Duffy S, Riemsma RP. Spinal fixation surgery for acute traumatic spinal cord injury. Cochrane Database Syst Rev. 2008 Jan 23. CD004725. [Medline].

  54. Gaebler C, Maier R, Kutscha-Lissberg F, Mrkonjic L, Vecsei V. Results of spinal cord decompression and thoracolumbar pedicle stabilisation in relation to the time of operation. Spinal Cord. 1999 Jan. 37(1):33-9. [Medline].

  55. Mirza SK, Krengel WF 3rd, Chapman JR, Anderson PA, Bailey JC, Grady MS. Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res. 1999 Feb. (359):104-14. [Medline].

  56. Vaccaro AR, Daugherty RJ, Sheehan TP, et al. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine. 1997 Nov 15. 22(22):2609-13. [Medline].

  57. Lyrica (pregabalin) [package insert]. New York, NY: Pfizer. June 2012. Available at [Full Text].

  58. Sanin L, Parsons B, et al. Weekly Assessments of Pain and Sleep During a 17-week, Double-blind, Placebo-controlled Trial of Pregabalin for the Treatment of Chronic Neuropathic Pain After Spinal Cord Injury. American Academy of Neurology 64th Annual Meeting. Emerging Science Poster #005. Presented April 25, 2012. New Orleans, LA.

  59. Annual Report for the Model Spinal Cord Injury Care Systems. December 2007;

  60. Fehlings MG, Perrin RG. The role and timing of early decompression for cervical spinal cord injury: update with a review of recent clinical evidence. Injury. 2005 Jul. 36 Suppl 2:B13-26. [Medline].

  61. Fisher CG, Noonan VK, Dvorak MF. Changing face of spine trauma care in North America. Spine (Phila Pa 1976). 2006 May 15. 31(11 Suppl):S2-8; discussion S36. [Medline].

  62. Goodman A. Pregabalin Rapidly Relieves Neuropathic Pain in Spinal Cord Injury. Medscape Medical News. Available at Accessed: May 18, 2013.

  63. Hurlbert RJ. Strategies of medical intervention in the management of acute spinal cord injury. Spine (Phila Pa 1976). 2006 May 15. 31(11 Suppl):S16-21; discussion S36. [Medline].

  64. Parsons B, Emir B. Examining the time-to-improvement of pain in patients with chronic neuropathic pain due to spinal cord injury. J Pain. April 2013. 14(4, Supplement):S60.

American Spinal Injury Association (ASIA) method for classifying spinal cord injury (SCI) by neurologic level.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.