Clinical examination has a low to very low sensitivity for identifying thoracolumbar spine injuries [16-18]. Therefore, a low threshold should be maintained for screening the thoracolumbar spine with imaging in the setting of blunt trauma, particularly in older patients, who are at increased risk for spine fractures occurring in the setting of low-energy trauma, such as a fall from standing (ie, fragility fractures), which are due to diminished bone mineralization commonly present in older patient populations. A low threshold for imaging of the thoracolumbar Suspected Spine Trauma spine should also be maintained for patients with disease processes known to cause spine rigidity, such as diffuse idiopathic skeletal hyperostosis or ankylosing spondylitis. Fractures found at one level of the spine are associated with injury at other noncontiguous levels of the spine in an estimated 20% of trauma patients [26,27]. Therefore, screening of the entire cervical spine should be considered whenever an injury of the thoracolumbar spine is identified in the setting of blunt trauma. Cervical, thoracic, and lumbar spine CT reconstructions can be performed from concurrently obtained neck CT angiograms, CT imaging of the thorax, or abdomen and pelvis in trauma patients who are also imaged for suspected soft-tissue or vascular injuries, providing the same image quality as a dedicated examination without Suspected Spine Trauma CT Myelography Cervical Spine There is no role for CT myelography in the initial assessment of patients with low risk for cervical spine injury. CT Cervical Spine CT is excellent at identifying cervical spine injuries. CT is considered the gold standard for identification of cervical spine fractures, outperforming radiographs in identification of cervical spine fractures in high-, moderate- and low-risk stratifications [31]. CT is inferior to MRI in identification of many soft-tissue injuries, such as epidural hematoma, cord contusion, and ligament sprains [37-42].
Suspected Spine Trauma PCAs. Clinical examination has a low to very low sensitivity for identifying thoracolumbar spine injuries [16-18]. Therefore, a low threshold should be maintained for screening the thoracolumbar spine with imaging in the setting of blunt trauma, particularly in older patients, who are at increased risk for spine fractures occurring in the setting of low-energy trauma, such as a fall from standing (ie, fragility fractures), which are due to diminished bone mineralization commonly present in older patient populations. A low threshold for imaging of the thoracolumbar Suspected Spine Trauma spine should also be maintained for patients with disease processes known to cause spine rigidity, such as diffuse idiopathic skeletal hyperostosis or ankylosing spondylitis. Fractures found at one level of the spine are associated with injury at other noncontiguous levels of the spine in an estimated 20% of trauma patients [26,27]. Therefore, screening of the entire cervical spine should be considered whenever an injury of the thoracolumbar spine is identified in the setting of blunt trauma. Cervical, thoracic, and lumbar spine CT reconstructions can be performed from concurrently obtained neck CT angiograms, CT imaging of the thorax, or abdomen and pelvis in trauma patients who are also imaged for suspected soft-tissue or vascular injuries, providing the same image quality as a dedicated examination without Suspected Spine Trauma CT Myelography Cervical Spine There is no role for CT myelography in the initial assessment of patients with low risk for cervical spine injury. CT Cervical Spine CT is excellent at identifying cervical spine injuries. CT is considered the gold standard for identification of cervical spine fractures, outperforming radiographs in identification of cervical spine fractures in high-, moderate- and low-risk stratifications [31]. CT is inferior to MRI in identification of many soft-tissue injuries, such as epidural hematoma, cord contusion, and ligament sprains [37-42].