Taiki Fukuda MD, Presenter: Nothing to Disclose

Kimiyoshi Mizunuma MD, Abstract Co-Author: Nothing to Disclose

Kazuhiko Morikawa, Abstract Co-Author: Nothing to Disclose

To investigate the incidence of spinal injuries and their complications in blunt trauma cases using trauma CT protocols.

This retrospective study was institutional review board approved. Among 2,980 patients with blunt trauma who underwent either Trauma Panscan (1,559 patients) or Trauma Head and Neck scan (1,421 patients), 170 patients with spinal injuries were identified by review of the official reports. CT protocols of the Trauma Panscan consisted of precontrast and postcontrast dual-phase scan. The precontrast scan covered the brain and neck. The arterial phase encompassed from the brain to the pelvis and the late phase from the chest to the pelvis. The Trauma Head and Neck scan was a brain and neck CT without contrast. MR imaging of the the spine was added in patients with any neurological symptoms. Two radiologists evaluated the images for evidence of spinal injuries and extra-spinal injuries.

Bony injuries were found in the thoracolumbar spine in 61 (35.9%) of 170 cases, the cervical spine in 44, the lumbar spine in 43, the thoracic spine in 31, the craniovertebral junction in 27 and the cervicothoracic spine in 25. Incidence of spinal cord injuries was highest in cases who had cervical spine injuries, 14 (31.8%) of 44 cases. There was one case of spinal cord injury without bone abnormalities. Extra-spinal injuries were present in 123 (72.4%); cranial fractures and/or intracranial bleeding in 47, hemo/pneumothorax in 29, pelvic ring injuries in 21, visceral injuries in 14 and aortic injuries in 5. Among 53 cases with lumbar transverse process fractures, visceral injuries were found in 10 (18.9%). Among 5 cases with aortic injury, 1st rib fracture was associated in 2 cases.

Spinal injuries were common in blunt trauma, and our trauma CT protocols are found to be useful in detecting these injuries. First rib fracture indicates a severe trauma, in which possible compliacations such as aortic and visceral injuries shoule be looked for. MRI should be performed if there is any neurological deficit even in cases without bony injuries. Visceral injuries should be checked in cases with fractures of the lumbar transverse process.

Trauma CT protocols can detect both spinal injuries and their complications are recommended as the first imaging examinations in cases with blunt trauma.

Fukuda, T, Mizunuma, K, Morikawa, K, Spinal Injuries in Blunt Trauma Patients: Detection with Trauma Panscan or Trauma Head and Neck Scan.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043444.html