II. Precautions

  1. Physical Exam is inadequate alone to exclude significant thoracolumbar spine injury
    1. Inaba (2011) J Trauma 70(1): 174-9 [PubMed]

III. Exam

  1. Vertebral tenderness
  2. Midline spine deformity
  3. Neurologic Exam correlated to spinal levels and Dermatomes
    1. Motor Exam
    2. Sensory Exam
    3. Reflex Exam

IV. Associated Conditions

  1. Vertebral Fracture (including Chance Fracture)
  2. Vertebral dislocation
  3. Vertebral instability
  4. Paraplegia
  5. Quadriplegia
  6. Nerve root injury

V. Imaging

  1. Indications
    1. Not alert
    2. Not able to be evaluated
    3. Positive physical exam findings
    4. High risk mechanism
    5. Age > 65 years old
    6. Inaba (2015) J Trauma Acute Care Surg 78(3): 459-65 [PubMed]
  2. Modalities
    1. Plain film xray is inadequate to exclude serious injury (misses 25% of burst Fractures)
      1. Ballock (1992) J Bone Joint Surg Br 74(1): 147-50 [PubMed]
    2. CT Imaging
      1. CT Thoracic Spine can be reconstructed from CT chest
      2. CT Lumbar Spine can be reconstructed from CT Abdomen and Pelvis
    3. MRI
      1. Consider spine MRI (especially in children and adolescents)

VI. References

  1. Jhun, Riddell and Inaba in Herbert (2016) EM:Rap 16(12): 13-4

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