Consider Using Computed Tomography Reconstructions of the Chest/Abdomen/Pelvis to Rule Out Thoracic and Lumbar Fractures and Dislocations
Suneel Khetarpal MD
Barbara Haas MD
Evaluation for the presence of thoracolumbar spine injury is frequently necessary in the multiply injured patient based on clinical findings, mechanism of injury, inability to adequately assess for injury due to decreased level of consciousness, or distracting injuries. Traditionally, the thoracolumbar spine was evaluated using anteroposterior and lateral plain films, but this modality is considered less than ideal for several reasons. Because the thoracolumbar spine cannot be adequately evaluated with portable radiographs, obtaining such films requires transportation of the critically injured patient away from areas equipped for emergency resuscitation. Moreover, a significant time delay between arrival in the trauma bay and completion of these films is documented. Most important, the sensitivity of plain films has been reported to be as low as 58%, with a high proportion of films being described as technically inadequate and requiring further computed tomography (CT) imaging.