Ebook ABC of imaging in trauma: Part 2
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Ebook ABC of imaging in trauma: Part 2
CHAPTER 7Thoracic and Lumbar Spine TraumaSivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard Ị. King2‘The Royal London Hospital. London. U Ebook ABC of imaging in trauma: Part 2UK’Southampton University Hospitals NHS Trust, Southampton, Hampshire. UKOVERVIEW•Spinal immobilization is a priority in multiple trauma patients but clearance is not•Imaging of the spine does not take precedence over life-saving procedures•Fractures of the thoracolumbar spine can be stable or unsta Ebook ABC of imaging in trauma: Part 2ble•Whole-bod,’ multidetector computed tomography gives high-quality images of the thoracic and lumbar spine•Magnetic resonance imaging can be usefulEbook ABC of imaging in trauma: Part 2
m selected cases following trauma particularly when there are abnormal neurological sgnsSignificant trauma is usually required to injure the thoracoluCHAPTER 7Thoracic and Lumbar Spine TraumaSivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard Ị. King2‘The Royal London Hospital. London. U Ebook ABC of imaging in trauma: Part 2t are frequently encountered in polytrauma victims and typically arise from motor vehicle collisions, sports activities or falls with the thoracolumbar junction at particular risk. Penetrating injuries to the spine are also occasionally encountered (Figure 7.1).Who to imageT he current standard for Ebook ABC of imaging in trauma: Part 2radiological evaluation of the thoracolumbar spine is not clearly defined and the decision to image will depend on the individual clinical scenario. BEbook ABC of imaging in trauma: Part 2
ritish Trauma Society guidelines advise that imaging is clearly indicated if there is pain, bruising.swelling.deformity or abnormal neurology which caCHAPTER 7Thoracic and Lumbar Spine TraumaSivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard Ị. King2‘The Royal London Hospital. London. U Ebook ABC of imaging in trauma: Part 2isleading, however, due to altered consciousness or distracting injury. Unconscious patients with a significant mechanism of injury should undergo imaging of the whole spine.There should be a high index of suspicion in patients who:•have fallen from a height•arc unconscious with multiple injuriesABC Ebook ABC of imaging in trauma: Part 2 of Imaging in Troitmo. By Leonard J. King and Dav»d c. Wherry Pubỉúhcd 2010 by lUickwdl Pubiuhing• have neurological symptoms or signs, or radiologicEbook ABC of imaging in trauma: Part 2
al evidence of fractures to the posterior ribs, scapula, sternum or calcaneum.Patients with underlying conditions such as known spinal malignancy, ostCHAPTER 7Thoracic and Lumbar Spine TraumaSivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard Ị. King2‘The Royal London Hospital. London. U Ebook ABC of imaging in trauma: Part 2f suspicion is necessary.Patients with one fracture of the thoracolumbar spine have a 5-15% overall risk of a second fracture, which may be discontinuous. This risk rises to around 40% in patients with burst fractures, and thus detection of one fracture should lead to evaluation of the entire spine Ebook ABC of imaging in trauma: Part 2for concomitant injuries.How to imageAnteroposterior (AP> and lateral radiographs are an appropriate first line investigation for patients with isolatEbook ABC of imaging in trauma: Part 2
ed spine injury, proceeding to computed tomography (CT) for further evaluation of potentially unstable injuries poorly demonstrated areas or equivocalCHAPTER 7Thoracic and Lumbar Spine TraumaSivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard Ị. King2‘The Royal London Hospital. London. U Ebook ABC of imaging in trauma: Part 2 CT data can be reformatted with a bony algorithm and small field of view to give detailed images with a high sensitivity for injuries. Additional erect radiographs are sometimes required by spinal surgeons to help assess the stability of injuries that may be suitable for non-operative management.Ma Ebook ABC of imaging in trauma: Part 2gnetic resonance imaging (MR!) is indicated in the presence of neurological symptoms or signs which may localize to the spinal cord or cauda equina inEbook ABC of imaging in trauma: Part 2
order to assess the extent of injury and ongoing neural compression (Figure 7.2). MRI is also particularly useful for demonstrating ligament injury, CHAPTER 7Thoracic and Lumbar Spine TraumaSivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard Ị. King2‘The Royal London Hospital. London. U Ebook ABC of imaging in trauma: Part 2njury without radiographic abnormality (SC1WORA). Cord oedema has a relatively favourable outcome compared with cord haemorrhage, and these may be distinguished on MR imaging thus providing useful prognostic information.Anatomy of vertebral bodiesThere arc twelve thoracic and five lumbar vertebrae, Ebook ABC of imaging in trauma: Part 2often with normal variation at the lumbar sacral junction, including a transitional vertebral body or incomplete fusion of the posterior elements. EacEbook ABC of imaging in trauma: Part 2
h vertebrae comprises of a body and spinous process56ThoraFigure 7.1 (a) Axis' ano (b> sagittal CT reconstruction of the thoracic spne demonstrating aCHAPTER 7Thoracic and Lumbar Spine TraumaSivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard Ị. King2‘The Royal London Hospital. London. U Ebook ABC of imaging in trauma: Part 2plus two paired pedicles, transverse processes, superior and interior articular facets, pars interarticularis and laminae. In the thoracic spine there are articular facets on the lateral aspect of the vertebral bodies for articulation with the ribs. The lumbar vertebral bodies are larger and have a Ebook ABC of imaging in trauma: Part 2horizxsntal spinous process. There are numerous ligaments that support the spine, including the anterior and posterior longitudinal ligaments, the ligEbook ABC of imaging in trauma: Part 2
amentum tlavum the inter-Figure 7-3 Sagittal shxt-tau inversion reccnery (STIR) MR Image dénonsưating radiographically occult ccrnp-esson fractures atCHAPTER 7Thoracic and Lumbar Spine TraumaSivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard Ị. King2‘The Royal London Hospital. London. U Ebook ABC of imaging in trauma: Part 2t.The thoracic spinal canal is narrow in relation to the spinal cord, which is therefore at risk of injury. The spinal cord ends at around58CHAPTER 7Thoracic and Lumbar Spine TraumaSivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard Ị. King2‘The Royal London Hospital. London. UGọi ngay
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