Variant 9: Age greater than or equal to 16 years. Blunt trauma meeting criteria for thoracic and lumbar imaging. Initial imaging. Imaging is a crucial component in assessment of thoracic and lumbar spine injury. From 1998 to 2011, there was an adjusted annual increase of approximately 8% in thoracolumbar spine fractures in patients involved in motor vehicle collisions [15]. Thoracolumbar fractures are challenging to identify clinically, with only 48% to 75% of thoracolumbar injuries identified on clinical examination [16-18]. Unlike cervical injuries, well-defined clinical criteria have not been established to determine when thoracolumbar imaging is appropriate in the setting of blunt traumatic injury. Since clinical examination has poor sensitivity for identifying thoracolumbar injuries, any high- risk patient (mid line thoracolumbar tenderness, high-energy mechanism of injury, or >60 years of age), as well as unexaminable patients (intoxicated, GCS <15, distracting injury), should undergo imaging of the thoracolumbar spine. Screening of the entire spine is advised, as an estimated 20% of spine injuries will have a second associated spinal injury at a noncontiguous level [26,27]. CT Myelography Thoracic and Lumbar Spine There is no role for CT myelography in the initial assessment of thoracolumbar spine injury. MRI Thoracic and Lumbar Spine Isolated unstable ligamentous injury in the absence of fractures appears to be extremely rare in the thoracolumbar spine, if it occurs at all. For this reason, screening the thoracolumbar spine with MRI to detect ligamentous disruption is not indicated when the CT scan is normal. As is the case for the cervical spine, symptoms or signs of spinal cord, conus medullaris, or nerve root injury indicate the need for imaging the symptomatic levels of the spine and spinal cord with MRI. Suspected Spine Trauma Variant 10: Age greater than or equal to 16 years. Acute thoracic or lumbar spine injury detected on radiographs or noncontrast CT.
Suspected Spine Trauma PCAs. Variant 9: Age greater than or equal to 16 years. Blunt trauma meeting criteria for thoracic and lumbar imaging. Initial imaging. Imaging is a crucial component in assessment of thoracic and lumbar spine injury. From 1998 to 2011, there was an adjusted annual increase of approximately 8% in thoracolumbar spine fractures in patients involved in motor vehicle collisions [15]. Thoracolumbar fractures are challenging to identify clinically, with only 48% to 75% of thoracolumbar injuries identified on clinical examination [16-18]. Unlike cervical injuries, well-defined clinical criteria have not been established to determine when thoracolumbar imaging is appropriate in the setting of blunt traumatic injury. Since clinical examination has poor sensitivity for identifying thoracolumbar injuries, any high- risk patient (mid line thoracolumbar tenderness, high-energy mechanism of injury, or >60 years of age), as well as unexaminable patients (intoxicated, GCS <15, distracting injury), should undergo imaging of the thoracolumbar spine. Screening of the entire spine is advised, as an estimated 20% of spine injuries will have a second associated spinal injury at a noncontiguous level [26,27]. CT Myelography Thoracic and Lumbar Spine There is no role for CT myelography in the initial assessment of thoracolumbar spine injury. MRI Thoracic and Lumbar Spine Isolated unstable ligamentous injury in the absence of fractures appears to be extremely rare in the thoracolumbar spine, if it occurs at all. For this reason, screening the thoracolumbar spine with MRI to detect ligamentous disruption is not indicated when the CT scan is normal. As is the case for the cervical spine, symptoms or signs of spinal cord, conus medullaris, or nerve root injury indicate the need for imaging the symptomatic levels of the spine and spinal cord with MRI. Suspected Spine Trauma Variant 10: Age greater than or equal to 16 years. Acute thoracic or lumbar spine injury detected on radiographs or noncontrast CT.