Thoracolumbar Spinal Injuries in Blunt Trauma, Screening for

Published 2012

Level 1

  1. When imaging is deemed necessary, MDCT scans with axial collimation should be used to screen for and diagnose, as MDCT scans are superior to plain films in identifying TLS fractures.

Level 2

  1. Patients with back pain, TLS tenderness on examination, neurologic deficits referable to the TLS, altered mental status, intoxication, distracting injuries, or known or suspected high-energy mechanisms should be screened for TLS injury with MDCT scan.
  2. ii. In blunt trauma patients with a known or suspected injury to the cervical spine, or any other region of the spine, thorough evaluation of the entire spine by MDCT scan should be strongly considered owing to a high incidence of spinal injury at multiple levels within this population.
  3. Patients without complaints of TLS pain that have normal mental status, as well as normal neurological and physical examinations may be excluded from TLS injury by clinical examination alone, without radiographic imaging, provided that there is no suspicion of high-energy mechanism or intoxication with alcohol or drugs.

Level 3

  1. MRI should be considered in consultation with the spine service for MDCT findings suggestive of neurologic involvement and of gross neurologic deficits.