Thoracic & Lumbar Spine Injury

Thoracolumbar spine imaging is indicated if there is pain, bruising, swelling, deformity or abnormal neurology attributable to the thoracic or lumbar spinal regions.

The presence of a fracture anywhere in the spine mandates full spinal imaging.

Unconscious patients who cannot be assessed clinically also require radiological clearance of the whole spine.

Initial Assessment of Spinal Trauma

Introduction
Spinal Stabilization
Clinical Clearance
Conscious Patients
Unconscious Patients
Thoracic & Lumbar Spine
Paediatric Spinal Injury

The standard imaging for the thoracic and lumbar spine are antero-posterior and lateral radiographs. CT scanning is carried out for any abnormal, suspicious or inadequately visualised ares. The scan should include the entire vertebral body above and below the level of injury, as these need to be uninjured if used for operative fixation. Patients with abnormal neurology attributable to the thoracic or lumbar spine should undergo an MRI scan to visualise the spinal cord.

Paediatric Spinal Injury

References

Durham RM, Luchtefeld WB, Wibbenmeyer L, Maxwell P, et al. Evaluation of the thoracic and lumbar spine after blunt trauma. Am J Surg 170(6): 681-684, 1995

Frankel HL, Rozycki GS, Ochsner MG, Harviel JD, et al. Indications for obtaining surveillance thoracic and lumbar spine radiographs. J Trauma 37(4): 673-676, 1994

Meldon SW and Moettus LN. Thoracolumbar spine fractures: clinical presentation and the effect of altered sensorium and major injury. J Trauma 39(6): 1110-1114, 1995

Spivak JM, Vaccaro AR and Cotler JM. Thoracolumbar Spine Trauma: I. Evaluation and Classification. J Am Acad Orthop Surg 3(6): 345-352, 1995

Paediatric Spinal Injury

trauma.org (7:4) April 2002