(BQ) Part 2 book “ABC of imaging in trauma” has contents: Thoracic and lumbar spine trauma, vascular trauma and interventional radiology, upper limb injuries, lower limb injuries, paediatric trauma, imaging trauma in pregnancy, bullets, bombs and ballistics, imaging of major incidents and mass casualty situations. | CHAPTER 7 Thoracic and Lumbar Spine Trauma Sivadas Ganeshalingam1, Muaaze Ahmad1, Evan Davies2 and Leonard J. King2 1 The Royal London Hospital, London, UK Southampton University Hospitals NHS Trust, Southampton, Hampshire, UK 2 O VER VIEW • 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 unstable • Whole-body multidetector computed tomography gives high-quality images of the thoracic and lumbar spine • Magnetic resonance imaging can be useful in selected cases following trauma particularly when there are abnormal neurological signs Significant trauma is usually required to injure the thoracolumbar spine, which is less mobile and better supported by surrounding anatomical structures than the cervical spine. Injuries can occur in isolation but 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 ). Who to image The current standard for radiological evaluation of the thoracolumbar spine is not clearly defined and the decision to image will depend on the individual clinical scenario. British Trauma Society guidelines advise that imaging is clearly indicated if there is pain, bruising, swelling, deformity or abnormal neurology which can be determined on clinical evaluation in alert, conscious patients, with no major distracting injuries. Clinical assessment is often incomplete or misleading, 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 • are unconscious with multiple injuries ABC of Imaging in .
