Imaging in Spinal Trauma
Section snippets
Indications for Imaging
There have been multiple studies investigating the necessity of imaging in trauma of the cervical spine. The general goal of these guidelines is to accurately predict which patients are at risk of cervical spine fractures, avoiding the potentially disastrous consequences of not diagnosing a cervical spine fracture. The secondary benefit of such guidelines is to reduce unnecessary examinations. The two largest studies are the NEXUS study and the Canadian C-spine study.
NEXUS (National Emergency
Plain Films versus CT
Plain films have been shown to be inferior to CT with respect to fracture detection in a number of studies,5, 6, 7, 8 although there are no randomized controlled trials comparing the two modalities; as such, a trial would be ethically unacceptable. A recent meta-analysis by Holmes and Akkinepalli9 showed that pooled sensitivities for plain radiography was 52% and for CT was 98% for identifying patients with cervical spine injury.
The question arises as to when it is appropriate to utilize CT as
Radiation Exposure
A subject that is often given little consideration in deciding how the cervical spine should be imaged is the relative radiation exposure between the different modalities. A study in the UK demonstrated that most doctors underestimate the dose of radiation from most diagnostic tests.15 Estimates from our institution are that the effective radiation dose from a CT of the cervical spine is 2.5 mSv compared with 0.04 mSv from a single radiograph of the cervical spine (standard three view would be
The Role of MRI
The role of magnetic resonance imaging (MRI) in acute spinal trauma is to evaluate neurological symptoms and suspected ligamentous disruption.4 MRI can directly visualize the spinal cord, allowing assessment of spinal cord compression, contusion, and hemorrhage. In acute traumatic myelopathy19 lesions such as epidural hematoma, acute disc prolapse, and ligamentous disruption are demonstrated to advantage. These entities are important to recognize as prompt surgical correction has the potential
Imaging of the Thoracolumbar Spine
There are no validated criteria for imaging the thoracolumbar spine. AP and lateral radiographs have been the traditional method of screening for injury in the thoracolumbar spine in trauma patients. As with imaging of the cervical spine, CT is being used with increasing frequency and there is increasing evidence that it is more accurate than plain radiography.
Trauma patients often undergo CT scanning of the chest, abdomen, and pelvis and the data obtained from this scan can be used to assess
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Cited by (6)
Role of CT scan in theranostic and management of traumatic spinal cord injury
2018, Saudi Journal of Biological SciencesCitation Excerpt :Sagittal cross section images make it possible to assess injury at noncontiguous levels. MRI also allows assessment of ligaments, disk, and soft tissues, as well as the spinal cord, conus medullaris, and cauda equine (Phal and Anderson, 2006; Rostamzadeh et al., 2015). The main objective of the study is to determine prevalence of TSCI in patients referred to the main trauma center in Tehran, Iran, with respect to the demographic characteristics of the patients to assess the role of CT scan in determination of fracture types and severity of the injury among the TSCI patients.
Spinal cord imaging
2017, Neurological Aspects of Spinal Cord InjuryDiagnostic imaging in mass casualty events
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2014, Seminars in Musculoskeletal RadiologyCore radiology: A visual approach to diagnostic imaging
2013, Core Radiology: A Visual Approach to Diagnostic ImagingAcute intraparenchymal spinal cord injury in a cat due to high-rise syndrome
2012, Canadian Veterinary Journal