CT in Spinal Trauma Emergencies

Abstract

The frequency of spinal trauma, which in developed countries affects 70% of cases under the age of 40, has gradually increased over the last 50 years. Typical causes of spinal trauma include road traffic accidents (50%), sports activities (25%), occupational accidents (20%) and accidental falls (5%) (19). Neurological injuries occur in 10-14% of cases of spinal trauma; 85% of these cases present at the time of the trauma, between 5-10% originate shortly afterwards, and between 510% become evident at a later time (9). Diagnostic and therapeutic advancements have increased patient survival rates; however, little can be done to reverse frank spinal cord injury. Improvements in survival rates have led to a parallel increase in the number of younger invalids. It is in part for this reason that prevention, rapid diagnosis and proper patient management are of paramount importance in minimizing neurological patient deficit (16). Timely radiological diagnosis is fundamental in the modern management of patients with spinal trauma. Mastery of this includes a thorough knowledge of the anatomy and biomechanics of the spine, an understanding of the mechanism of the trauma, experience in the correct execution of radiological examinations, knowledge of the indications and limitations of the individual imaging techniques under consideration and a correct appreciation of the importance of the correlation between the imaging findings and the clinical signs and symptoms. Practically speaking, the spinal column has two functions: to facilitate stability and movement, and to protect the spinal cord and spinal nerves. Consequently, we have two separate yet closely connected considerations when evaluating the patient with spinal trauma: the spinal column itself and the underlying neural and meningeal structures. At the level of the present state of the art, medical imaging techniques make it possible to glean information concerning all components of the spine, including its contents and the perivertebral tissues. Conventional radiology, CT and MRI are the techniques currently available, although the most advanced techniques do not necessarily represent the best ones in every case (2, 12, 15). Fundamental diagnostic information is provided by conventional x-rays which, when complemented by conventional tomography, are the best choice for evaluating acute trauma of the spinal column itself. Radiographic analysis also makes it possible to perform the examination in 5.2