CT in the evaluation of spine trauma

Fifteen patients admitted for spine trauma in an 8 month period were studied with computed tomography (CT). All the patients had initial routine plain film screening, and 10 of 15 were also examined with conventional tomography. Five patients sustained vertical fall, axial-load injuries in the thoracolumbar junction region; two others suffered missile injury to the spine. CT provided more information than plain films in all these patients due to its superior imaging of bony detail and its ability to assess soft-tissue damage. In four of these patients, conventional tomography was done but contributed no additional information. Eight other patients sustained complex fractures of the cervical spine. In all but one, the combination of plain films and CT allowed complete evaluation of the injury. In one patient, conventional tomography showed an additional linear fracture one vertebral level below the main region of injury. Plain films and CT allow complete, safe, rapid, easily interpretable evaluation of spine trauma patients in the acute setting. Conventional tomography yields no additional clinically vital information in the acute evaluation of spine trauma, when plain films are abnormal. Its current ability to show finer bony detail than CT can be reserved for evaluating equivocal plain film and CT findings or more complete evaluation (if indicated) after the patient is clinically stable.