EMERGENCY RADIOLOGY

SPECIAL FEATURE: REVIEW

ARTICLE
The role of emergency
radiology in spinal trauma
Arranged by : Christine Octaviani
In Guidance of : Dr. Komala Dewi Sp.Rad
 Spinal trauma  frequent injury

Differ severity and prognosis.

Abstract
Asymptomatic condition to temporary neurological dysfunction, focal
deficit or fatal event

major causes : high and low energy fall, traffic accident, sport and blunt
impact
Aim of this Paper

Incidence and type of vertebral fracture

Imaging indication and guidelines for cervical trauma

Imaging indication and guidelines for thoracolumbar trauma

Multidetector CT indication for trauma spine

MRI indication and protocol for trauma spine

 INTRODUCTION
Trauma of the spine weighs Incidence in US 15 – 40
case / million  12,000 Adult  most frequent
heavily on the budget of
paraplegia, 4000 deaths Road accident, fall from
social and economic prehospital, 1000 during high and sports injuries
development hospitalization

Quick and proper

management of the
Radiologist : presence /
patients with trauma, from
absence of lesion 
diagnosis to therapy 
prognostic & treatment
Reduce neurological
damage
Vertebral fracture management and imaging
indication and evaluation

Imaging in Spinal Trauma

Diagnose traumatic Abnormality & Characterize type of injury

Estimate severity, potential spinal instability, with / without neurological

lesion associated

Evaluate Spinal cord and surrounding structure

Cervical spinal trauma: standard X-ray and
multidetector CT indication

Xray 3 projection
: AP, Lateral +
Imaging odontoid view
Methods for
Cervical level
MDCT
 Minor
Type of
Trauma
Major
 Trauma Risk
Factor

Violence of Associated
Patient’s Age Clinical Sign
trauma lesion

High / Low <5 yo, >65 Vertebra Neurological

GCS
energy fall yo deformation deficit
 • Unconcious
• Sedated
HIGH • Intoxicated
• Non cooperative
RISK • Distracting injury
• GCS < 15

• GCS 15
LOW • Alert
• Non Intoxicated
RISK • X distracting Injury
Nexus Criteria
• no tenderness at the posterior midline of the cervical spine
• (2) no focal neurologic deficit
• (3) normal level of alertness
• (4) no evidence of intoxication
• (5) no clinically apparent painful injury that might distract the
• patient from the pain of a cervical spine injury.6
Canadian C-Spine Rule
• 3 High Risk Criteria
• Age : > 65 yo
• Dangerous mechanism • Risk factor not present
• Paraesthesia in extrimities • Nexus Criteria
• 5 Low risk Criteria • Cervical spine movement
• Simple rear end motor vehicle collision left and right rotation >
• Sitting position in ER 45degree
• Ambulatory at any time
• Delayed onset f nect pain
• Absent of midline cervical spine tenderness

• Patient ability to rotate neck actively

• MDCT > Conventional radiography
Disadvantages of MDCT
- No information about spinal cord status, can only be obtained by
clinical data

CCT  cerebrovascular injury by blunt trauma

Use of contras to exclude Hemorrhagic brain lesion and cervical
fracture  not needed
 Spinal trauma and MRI
• MDCT  first Imaging modality in patient with trauma
• MRI  essential
• Ligament
• Muscle
• Spinal cord injury ; Spinal cord, disc, ligament, neural
elements
Classify burst fracture,
Status of post. Lig. Complex
 MRI in Spinal Trauma
• In the absence of vertebral fracture, patients can suffer from back
pain resistant to medical therapy owing to bone marrow traumatic
oedema that can be detected only using STIR sequence on MRI

• MRI is the only imaging modality that can detect intramedullary or

extramedullary pathologies or show the absence of neuroimaging
abnormalities
Vertebral fracture type and
classification
Vertebral
Compression Fracture

Burst Fracture
 Classification

Dennis 3 Column Magerl VCF Trauma

Concept Force Categories
•Anterior •Compression
•Middle •Distraction
•Posterior •Rotation
Thoracolumbar fracture and mini-invasive
vertebral augmentation procedure: imaging
target
• Balloon Kyphoplasty KP or kyphoplasty like techniques 
pain relief and kyphosis correction (Non surgical
symptomatic vertebral fracture)
 Conclusion
• Management of Spinal Trauma 
COMPLEX
• MDCT  bone evaluation for severe
trauma, high risk spine injury
• MRI  spinal cord injury in absence of
lesion