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Evaluation of thoracic and lumbar spinal column injury

Amy Kaji, MD, PhD
Robert S Hockberger, MD, FACEP
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Although less common than cervical spinal column injuries, injuries of the thoracolumbar spinal column can be devastating and are commonly associated with major injuries of the chest and abdomen following high-energy trauma. The evaluation of thoracic and lumbar spinal column injuries in adults is reviewed here.

The evaluation and acute management of cervical spinal column injuries, spinal cord injuries, and spinal injuries in children are discussed separately. (See "Evaluation and acute management of cervical spinal column injuries in adults" and "Spinal column injuries in adults: Definitions, mechanisms, and radiographs" and "Acute traumatic spinal cord injury" and "Evaluation of cervical spine injuries in children and adolescents".)


The epidemiology of spinal column injuries and the anatomy of the spinal column are reviewed separately. (See "Spinal column injuries in adults: Definitions, mechanisms, and radiographs".)


Common mechanisms of injury, classification schemes, and important types of thoracolumbar (TL) spinal column injuries are discussed separately. (See "Spinal column injuries in adults: Definitions, mechanisms, and radiographs", section on 'Mechanisms of injury' and "Spinal column injuries in adults: Definitions, mechanisms, and radiographs", section on 'Thoracic and lumbar (TL) spinal column injury'.)


The acute management of spinal cord and spinal column injuries is discussed separately, as is the general management of the trauma patient. (See "Evaluation and acute management of cervical spinal column injuries in adults", section on 'Initial management' and "Acute traumatic spinal cord injury" and "Initial management of trauma in adults".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 10, 2016.
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  1. Malik MH, Lovell ME. Current spinal board usage in emergency departments across the UK. Injury 2003; 34:327.
  2. Vickery D. The use of the spinal board after the pre-hospital phase of trauma management. Emerg Med J 2001; 18:51.
  3. Stagg MJ, Lovell ME. A repeat audit of spinal board usage in the emergency department. Injury 2008; 39:323.
  4. Kwan I, Bunn F, Roberts I. Spinal immobilisation for trauma patients. Cochrane Database Syst Rev 2001; :CD002803.
  5. Hauswald M, Hsu M, Stockoff C. Maximizing comfort and minimizing ischemia: a comparison of four methods of spinal immobilization. Prehosp Emerg Care 2000; 4:250.
  6. Hauswald M, Braude D. Spinal immobilization in trauma patients: is it really necessary? Curr Opin Crit Care 2002; 8:566.
  7. Inaba K, DuBose JJ, Barmparas G, et al. Clinical examination is insufficient to rule out thoracolumbar spine injuries. J Trauma 2011; 70:174.
  8. Meves R, Avanzi O. Correlation between neurological deficit and spinal canal compromise in 198 patients with thoracolumbar and lumbar fractures. Spine (Phila Pa 1976) 2005; 30:787.
  9. Denis F, Armstrong GW, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res 1984; :142.
  10. McDonough PW, Davis R, Tribus C, Zdeblick TA. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976) 2004; 29:1901.
  11. Spector LR, Madigan L, Rhyne A, et al. Cauda equina syndrome. J Am Acad Orthop Surg 2008; 16:471.
  12. Esposito TJ, Ingraham A, Luchette FA, et al. Reasons to omit digital rectal exam in trauma patients: no fingers, no rectum, no useful additional information. J Trauma 2005; 59:1314.
  13. Porter JM, Ursic CM. Digital rectal examination for trauma: does every patient need one? Am Surg 2001; 67:438.
  14. Shlamovitz GZ, Mower WR, Bergman J, et al. Poor test characteristics for the digital rectal examination in trauma patients. Ann Emerg Med 2007; 50:25.
  15. Guldner GT, Brzenski AB. The sensitivity and specificity of the digital rectal examination for detecting spinal cord injury in adult patients with blunt trauma. Am J Emerg Med 2006; 24:113.
  16. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS) Student Course Manual, 9th ed, American College of Surgeons, Chicago 2012.
  17. Gordon ZL, Gillespie RJ, Ponsky TA, et al. Three siblings with Chance fractures: the importance of 3-point restraints. J Pediatr Orthop 2009; 29:856.
  18. Keene, GS, Edwards, DJ, Robinson, AHN, Bowditch, MG. Key topics in orthopaedic trauma surgery, Bios Scientific, Oxford 1999.
  19. Sava J, Williams MD, Kennedy S, Wang D. Thoracolumbar fracture in blunt trauma: is clinical exam enough for awake patients? J Trauma 2006; 61:168.
  20. Gill DS, Mitra B, Reeves F, et al. Can initial clinical assessment exclude thoracolumbar vertebral injury? Emerg Med J 2013; 30:679.
  21. Inaba K, Nosanov L, Menaker J, et al. Prospective derivation of a clinical decision rule for thoracolumbar spine evaluation after blunt trauma: An American Association for the Surgery of Trauma Multi-Institutional Trials Group Study. J Trauma Acute Care Surg 2015; 78:459.
  22. Cooper C, Dunham CM, Rodriguez A. Falls and major injuries are risk factors for thoracolumbar fractures: cognitive impairment and multiple injuries impede the detection of back pain and tenderness. J Trauma 1995; 38:692.
  23. Frankel HL, Rozycki GS, Ochsner MG, et al. Indications for obtaining surveillance thoracic and lumbar spine radiographs. J Trauma 1994; 37:673.
  24. Durham RM, Luchtefeld WB, Wibbenmeyer L, et al. Evaluation of the thoracic and lumbar spine after blunt trauma. Am J Surg 1995; 170:681.
  25. Meldon SW, Moettus LN. Thoracolumbar spine fractures: clinical presentation and the effect of altered sensorium and major injury. J Trauma 1995; 39:1110.
  26. Sixta S, Moore FO, Ditillo MF, et al. Screening for thoracolumbar spinal injuries in blunt trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73:S326.
  27. Holmes JF, Panacek EA, Miller PQ, et al. Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. J Emerg Med 2003; 24:1.
  28. Hsu JM, Joseph T, Ellis AM. Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury 2003; 34:426.
  29. O'Connor E, Walsham J. Review article: indications for thoracolumbar imaging in blunt trauma patients: a review of current literature. Emerg Med Australas 2009; 21:94.
  30. Holmes JF, Miller PQ, Panacek EA, et al. Epidemiology of thoracolumbar spine injury in blunt trauma. Acad Emerg Med 2001; 8:866.
  31. Nelson DW, et al. Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma. J Trauma 2013; 75:135.
  32. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS) Student Course Manual, 9th ed, American College of Surgeons, Chicago 2012.
  33. Kim S, Yoon CS, Ryu JA, et al. A comparison of the diagnostic performances of visceral organ-targeted versus spine-targeted protocols for the evaluation of spinal fractures using sixteen-channel multidetector row computed tomography: is additional spine-targeted computed tomography necessary to evaluate thoracolumbar spinal fractures in blunt trauma victims? J Trauma 2010; 69:437.
  34. Diaz JJ Jr, Cullinane DC, Altman DT, et al. Practice management guidelines for the screening of thoracolumbar spine fracture. J Trauma 2007; 63:709.
  35. Langdorf MI, Zuabi N, Khan NA, et al. Yield and clinical predictors of thoracic spine injury from chest computed tomography for blunt trauma. West J Emerg Med 2014; 15:465.
  36. Brandt MM, Wahl WL, Yeom K, et al. Computed tomographic scanning reduces cost and time of complete spine evaluation. J Trauma 2004; 56:1022.
  37. Rhee PM, Bridgeman A, Acosta JA, et al. Lumbar fractures in adult blunt trauma: axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films. J Trauma 2002; 53:663.
  38. Gestring ML, Gracias VH, Feliciano MA, et al. Evaluation of the lower spine after blunt trauma using abdominal computed tomographic scanning supplemented with lateral scanograms. J Trauma 2002; 53:9.
  39. Inaba K, Munera F, McKenney M, et al. Visceral torso computed tomography for clearance of the thoracolumbar spine in trauma: a review of the literature. J Trauma 2006; 60:915.
  40. Hauser CJ, Visvikis G, Hinrichs C, et al. Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. J Trauma 2003; 55:228.
  41. Mancini DJ, Burchard KW, Pekala JS. Optimal thoracic and lumbar spine imaging for trauma: are thoracic and lumbar spine reformats always indicated? J Trauma 2010; 69:119.
  42. Antevil JL, Sise MJ, Sack DI, et al. Spiral computed tomography for the initial evaluation of spine trauma: A new standard of care? J Trauma 2006; 61:382.
  43. Blackmore CC, Ramsey SD, Mann FA, Deyo RA. Cervical spine screening with CT in trauma patients: a cost-effectiveness analysis. Radiology 1999; 212:117.
  44. Grogan EL, Morris JA Jr, Dittus RS, et al. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan. J Am Coll Surg 2005; 200:160.
  45. Brown CV, Antevil JL, Sise MJ, Sack DI. Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: its time has come. J Trauma 2005; 58:890.
  46. Goldberg AL, Kershah SM. Advances in imaging of vertebral and spinal cord injury. J Spinal Cord Med 2010; 33:105.
  47. Dai LY, Ding WG, Wang XY, et al. Assessment of ligamentous injury in patients with thoracolumbar burst fractures using MRI. J Trauma 2009; 66:1610.
  48. van Middendorp JJ, Patel AA, Schuetz M, Joaquim AF. The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature. Eur Spine J 2013; 22:461.
  49. Siebenga J, Leferink VJ, Segers MJ, et al. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine (Phila Pa 1976) 2006; 31:2881.
  50. Joaquim AF, Patel AA. Thoracolumbar spine trauma: Evaluation and surgical decision-making. J Craniovertebr Junction Spine 2013; 4:3.
  51. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 2005; 30:2325.
  52. Kepler CK, Vaccaro AR, Schroeder GD, et al. The Thoracolumbar AOSpine Injury Score. Global Spine J 2016; 6:329.