Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: Its time has come

Carlos V R Brown, Jared L. Antevil, Michael J. Sise, Daniel I. Sack, West Livaudais, James W. Davis, Arthur Cooper, George Velmahos

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Background: Although the traditional method of diagnosing spine fractures (SF) has been plain radiography, Spiral Computed Tomography (SCT) is being used with increasing frequency. Our institution adopted SCT as the primary modality for the diagnosis of SF. The purpose of this study was to determine whether SCT scan can be used as a stand-alone diagnostic modality in the evaluation of SF. Methods: Retrospective review of all blunt trauma patients over a two year period (1/01 - 12/02). Patients with neck pain, back pain, or spine tenderness underwent SCT of the symptomatic region. Patients who were unconscious or intoxicated underwent screening SCT of the entire spine. SCT was performed using 5 mm axial cuts with three-dimensional reconstructions in sagittal and coronal planes. Patients with a discharge diagnosis of cervical, thoracic, or lumbar SF were identified from the trauma registry by ICD-9 codes. Results: There were 3,537 blunt trauma patients evaluated, with 236 (7%) sustaining a cervical, thoracic, or lumbar SF. Forty-five patients (19%) sustained a SF in more than one anatomic region. SCT missed SF in two patients. The cervical SF missed by SCT was a compression fracture identified by magnetic resonance imaging and was treated with a rigid collar. The thoracic SF missed by SCT was also a compression fracture identified on plain radiographs and required no treatment. Conclusions: SCT of the spine identified 99.3% of all fractures of the cervical, thoracic, and lumbar spine, and those missed by SCT required minimal or no treatment. SCT is a sensitive diagnostic test for the identification of SF. Routine plain radiographs of the spine are not necessary in the evaluation of blunt trauma patients.

Original languageEnglish (US)
Pages (from-to)890-896
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume58
Issue number5
DOIs
StatePublished - May 2005

Fingerprint

Spiral Computed Tomography
Spine
Thorax
Compression Fractures
Wounds and Injuries
International Classification of Diseases
Neck Pain
Back Pain
Routine Diagnostic Tests
Radiography
Registries

Keywords

  • Cervical spine
  • Computed tomography spine fracture
  • Lumbar spine
  • Thoracic spine

ASJC Scopus subject areas

  • Surgery

Cite this

Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures : Its time has come. / Brown, Carlos V R; Antevil, Jared L.; Sise, Michael J.; Sack, Daniel I.; Livaudais, West; Davis, James W.; Cooper, Arthur; Velmahos, George.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 58, No. 5, 05.2005, p. 890-896.

Research output: Contribution to journalArticle

Brown, Carlos V R ; Antevil, Jared L. ; Sise, Michael J. ; Sack, Daniel I. ; Livaudais, West ; Davis, James W. ; Cooper, Arthur ; Velmahos, George. / Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures : Its time has come. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 58, No. 5. pp. 890-896.
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abstract = "Background: Although the traditional method of diagnosing spine fractures (SF) has been plain radiography, Spiral Computed Tomography (SCT) is being used with increasing frequency. Our institution adopted SCT as the primary modality for the diagnosis of SF. The purpose of this study was to determine whether SCT scan can be used as a stand-alone diagnostic modality in the evaluation of SF. Methods: Retrospective review of all blunt trauma patients over a two year period (1/01 - 12/02). Patients with neck pain, back pain, or spine tenderness underwent SCT of the symptomatic region. Patients who were unconscious or intoxicated underwent screening SCT of the entire spine. SCT was performed using 5 mm axial cuts with three-dimensional reconstructions in sagittal and coronal planes. Patients with a discharge diagnosis of cervical, thoracic, or lumbar SF were identified from the trauma registry by ICD-9 codes. Results: There were 3,537 blunt trauma patients evaluated, with 236 (7{\%}) sustaining a cervical, thoracic, or lumbar SF. Forty-five patients (19{\%}) sustained a SF in more than one anatomic region. SCT missed SF in two patients. The cervical SF missed by SCT was a compression fracture identified by magnetic resonance imaging and was treated with a rigid collar. The thoracic SF missed by SCT was also a compression fracture identified on plain radiographs and required no treatment. Conclusions: SCT of the spine identified 99.3{\%} of all fractures of the cervical, thoracic, and lumbar spine, and those missed by SCT required minimal or no treatment. SCT is a sensitive diagnostic test for the identification of SF. Routine plain radiographs of the spine are not necessary in the evaluation of blunt trauma patients.",
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T1 - Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures

T2 - Its time has come

AU - Brown, Carlos V R

AU - Antevil, Jared L.

AU - Sise, Michael J.

AU - Sack, Daniel I.

AU - Livaudais, West

AU - Davis, James W.

AU - Cooper, Arthur

AU - Velmahos, George

PY - 2005/5

Y1 - 2005/5

N2 - Background: Although the traditional method of diagnosing spine fractures (SF) has been plain radiography, Spiral Computed Tomography (SCT) is being used with increasing frequency. Our institution adopted SCT as the primary modality for the diagnosis of SF. The purpose of this study was to determine whether SCT scan can be used as a stand-alone diagnostic modality in the evaluation of SF. Methods: Retrospective review of all blunt trauma patients over a two year period (1/01 - 12/02). Patients with neck pain, back pain, or spine tenderness underwent SCT of the symptomatic region. Patients who were unconscious or intoxicated underwent screening SCT of the entire spine. SCT was performed using 5 mm axial cuts with three-dimensional reconstructions in sagittal and coronal planes. Patients with a discharge diagnosis of cervical, thoracic, or lumbar SF were identified from the trauma registry by ICD-9 codes. Results: There were 3,537 blunt trauma patients evaluated, with 236 (7%) sustaining a cervical, thoracic, or lumbar SF. Forty-five patients (19%) sustained a SF in more than one anatomic region. SCT missed SF in two patients. The cervical SF missed by SCT was a compression fracture identified by magnetic resonance imaging and was treated with a rigid collar. The thoracic SF missed by SCT was also a compression fracture identified on plain radiographs and required no treatment. Conclusions: SCT of the spine identified 99.3% of all fractures of the cervical, thoracic, and lumbar spine, and those missed by SCT required minimal or no treatment. SCT is a sensitive diagnostic test for the identification of SF. Routine plain radiographs of the spine are not necessary in the evaluation of blunt trauma patients.

AB - Background: Although the traditional method of diagnosing spine fractures (SF) has been plain radiography, Spiral Computed Tomography (SCT) is being used with increasing frequency. Our institution adopted SCT as the primary modality for the diagnosis of SF. The purpose of this study was to determine whether SCT scan can be used as a stand-alone diagnostic modality in the evaluation of SF. Methods: Retrospective review of all blunt trauma patients over a two year period (1/01 - 12/02). Patients with neck pain, back pain, or spine tenderness underwent SCT of the symptomatic region. Patients who were unconscious or intoxicated underwent screening SCT of the entire spine. SCT was performed using 5 mm axial cuts with three-dimensional reconstructions in sagittal and coronal planes. Patients with a discharge diagnosis of cervical, thoracic, or lumbar SF were identified from the trauma registry by ICD-9 codes. Results: There were 3,537 blunt trauma patients evaluated, with 236 (7%) sustaining a cervical, thoracic, or lumbar SF. Forty-five patients (19%) sustained a SF in more than one anatomic region. SCT missed SF in two patients. The cervical SF missed by SCT was a compression fracture identified by magnetic resonance imaging and was treated with a rigid collar. The thoracic SF missed by SCT was also a compression fracture identified on plain radiographs and required no treatment. Conclusions: SCT of the spine identified 99.3% of all fractures of the cervical, thoracic, and lumbar spine, and those missed by SCT required minimal or no treatment. SCT is a sensitive diagnostic test for the identification of SF. Routine plain radiographs of the spine are not necessary in the evaluation of blunt trauma patients.

KW - Cervical spine

KW - Computed tomography spine fracture

KW - Lumbar spine

KW - Thoracic spine

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