'Routine' radiologic evaluation of the thoracolumbar spine in blunt trauma patients: a reappraisal

A retrospective review of 756 blunt trauma cases at a level I trauma center was conducted to determine the role of thoracolumbar (TL) spine roentgenograms in the management of asymptomatic patients. Thoracolumbar spine films were obtained on 106 patients. The charts from 99 patients were available for thorough review. Fifty-five patients had negative clinical evidence of TL spine injury; all of these (100%) had negative radiographic evidence of fracture or dislocation on the TL spine films. Twenty-four patients had positive clinical evidence of TL spine injury; 14 (58%) had corresponding radiographic evidence of TL spine injury. Of the 20 patients in whom the clinical examination was equivocal, one (5%) had radiographic evidence of TL spine injury. We conclude that physical examination is reliable for assessing the TL spine, and that in the absence of clinical evidence of injury, TL spine films are unnecessary. In patients with equivocal examinations, TL spine films should be obtained because 7% (one of 15) of the injuries were identified in this group.