We see a lot of patients with mechanisms of injury and/or clinical signs that suggest a spinal column injury. Should you image the whole spine or just the areas that you think might be fractured?
There is NICE guidance on this (see link below)
The incidence of non-contiguous fractures is probably about 10% in published studies. That figure is also quoted in ATLS.
With such a high incidence of additional fractures, then as TTL you should start with the idea that all patients with a suspected spinal column injury need to have their whole spine imaged.
Only if you can find a specific reason not to, should you then not image the whole spine. CT is best for bony injury. MR is best for soft tissue injury and trabecular fractures. On the Major trauma ward, and in conjunction with our spinal surgical colleagues, we usually do both during the patient’s stay.
There will occasionally be exceptions to this. For example:
- Fragility fractures are an example where this is not always required.
- Penetrating trauma injuries that are clearly localised to a body area.
- Isolated neck injury.
- Plain films can be used as a screening tool for thoraco-lumbar injury according to NICE, but for significant MOIs we advocate a CT first approach.
Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma https://pubmed.ncbi.nlm.nih.gov/23940857/
Diagnostic imaging in hospital for spinal injury https://pathways.nice.org.uk/pathways/trauma#path=view%3A/pathways/trauma/diagnostic-imaging-in-hospital-for-spinal-injury.xml&content=view-index
