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
  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

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Injury of thoracic spine (C0432667)

Concepts Injury or Poisoning (T037)
SnomedCT 262523007
English injuries spine thoracic, injury of thoracic spine, thoracic spine injury, injury spine thoracic, Injury of thoracic spine, Injury of thoracic spine (disorder)
Spanish lesión de columna vertebral dorsal (trastorno), lesión de columna vertebral dorsal

Ontology: Injury of lumbar spine (C0432668)

Concepts Injury or Poisoning (T037)
SnomedCT 262524001
Italian Traumatismo del midollo spinale lombare
Japanese 腰椎部脊髄損傷, ヨウツイブセキズイソンショウ
English injury of lumbar spinal cord, injury of lumbar spinal cord (diagnosis), Spinal cord injury lumbar, injuries lumbar spine, injury lumbar spine, injury of lumbar spine, cord injuries lumbar spinal, lumbar spine injury, Injury of lumbar spine, Injury of lumbar spine (disorder), injury; spinal cord, lumbar
Czech Poranění bederní míchy
Hungarian Lumbalis gerincvelősérülés
Dutch letsel; ruggenmerg, lumbaal, ruggenmergletsel lumbaal
Spanish lesión de columna vertebral lumbar (trastorno), lesión de columna vertebral lumbar, Lesión traumática de la médula espinal lumbar
Portuguese Lesão traumática da medula lombar
French Lésion de la moelle lombaire
German Rueckenmarksverletzung lumbal