Keywords:
Trauma, Diagnostic procedure, MR, CT, Conventional radiography, Musculoskeletal spine
Authors:
R. Moutinho, P. Tyrrell, V. Cassar-Pullicino; Oswestry, Shropshire/UK
DOI:
10.1594/essr2017/P-0286
Background
Spinal injuries constitute a significant proportion of musculoskeletal injuries across the world1,2.
The thoracolumbar spine represents the most common area fractured in the spine3.
Spine stability is defined as the ability to prevent the development of neurologic injury and progressive deformity in response to physiologic loading and a normal range of movement4.
From a spinal surgeon’s point of view,
most descriptions used are based on the Denis model5 (Fig.1).
Instability varies over time depending on the nature of the structures involved.
Bone instability can be temporary and ligament instability can be permanent in the absence of surgical fixation.
The posterior ligamentous complex (PLC) (Fig.2) is the primary tension band and protects the spine from excessive flexion,
rotation,
translation and distraction.
Without surgery,
an injured PLC can result in Kyphotic progression and subsequent vertebral collapse6.
Multidetector CT (MDCT),
currently,
is the imaging modality of choice,
when there is a high or moderate index of suspicion of spine injury in a trauma setting.
Radiographs are not usually obligatory prior to CT for acute spinal trauma,
since a negative radiograph does not exclude obtaining a spine CT,
if the clinical index is high.
The standard of care today is to use MDCT technology with ≥ 16 detector channels in polytrauma patients.
MRI,
with superior soft tissue characterization,
provides the best evaluation of soft tissue pathology and essentially the only direct evaluation of the spinal cord.
Information obtained regarding disks,
ligaments,
hematomas,
and the spinal cord is often complementary to the evaluation of osseous damage provided by CT scanning.
The MRI protocol for spine trauma should include T1-weighted sequences,
T2-weighted sequences and short tau inversion recovery (STIR) or fat-saturated (FS) T2-weighted sequences. (Fig.3)