Region matters in Spinal Trauma: Diagnostic Performance of Conventional Radiography in a Retrospective Cohort with...

Area of Science:

• Radiology
• Orthopedic Surgery
• Trauma Imaging

Background:

• Accurate diagnosis of traumatic spinal fractures is critical for effective patient treatment.
• Conventional radiography is a primary imaging modality for spinal trauma assessment.
• Understanding region-specific performance is key to optimizing diagnostic strategies.

Purpose of the Study:

• To evaluate the region-specific performance characteristics of posttraumatic spinal radiography.
• To assess the diagnostic accuracy of radiography for detecting spinal fractures across different regions (cervical, thoracic, lumbar).
• To compare radiation dose metrics across spinal regions.

Main Methods:

• Retrospective analysis of 474 posttraumatic two-view radiograms (cervical, thoracic, lumbar spine).
• Evaluation of cohort characteristics, trauma mechanisms, and fracture suspicion rates.
• Assessment of diagnostic accuracy in a subgroup (n=76) using CT/MRI as reference, examining fracture presence, severity, and involvement patterns.
• Comparison of dose-area products across imaging regions.

Main Results:

• Fracture suspicion was highest in the lumbar spine (22.2%) compared to thoracic (13.5%) and cervical (0.5%).
• Radiation dose (dose-area product) was lowest for cervical spine imaging.
• Radiography demonstrated high specificity (≥87.5%) but variable sensitivity; accuracy was highest in the cervical spine and lowest in the thoracic spine for fracture severity and posterior edge involvement.

Conclusions:

• The diagnostic performance of spinal radiography in trauma is significantly region-dependent.
• Cervical and lumbar spine radiography are reliable for initial evaluation of mild spinal trauma.
• Thoracic spine radiography has limited reliability for assessing fracture severity and posterior involvement, suggesting a lower threshold for advanced imaging (CT/MRI).