Thoracolumbar spine trauma

Last reviewed: 8 Nov 2022
Last updated: 21 Oct 2022

Summary

Definition

History and exam

Key diagnostic factors

  • history of mechanical trauma
  • past medical history of osteoporosis or neoplasm
  • back pain
  • bruising
  • acute numbness/paresthesia
  • weakness
  • muscle spasticity/clonus (hypertonicity) or hypotonia
  • hyperreflexia or hyporeflexia
  • Hoffman sign
  • positive Babinski sign
  • spinal deformity
  • loss of anal sphincter reflex
More key diagnostic factors

Other diagnostic factors

  • absence of bulbocavernosus reflex (S3-S4)
  • signs of spinal shock (hypotonia or flaccidity that resolves within 24 hours)
  • urinary incontinence
  • painless urinary retention
Other diagnostic factors

Risk factors

  • falling from a height
  • high-energy mechanism of injury
  • age >65 years
  • concomitant osteoporosis
  • previous vertebral fracture
  • underlying neoplastic lesion
  • underlying metabolic or inflammatory disorders
  • male sex
More risk factors

Diagnostic investigations

1st investigations to order

  • Noncontrast multidetector CT spine (MDCT)
More 1st investigations to order

Investigations to consider

  • thoracolumbar spine x-ray (anterior-posterior and lateral views)
  • MRI spine
  • CT myelography
  • MRI with STIR sequence
  • Whole body CT
More investigations to consider

Treatment algorithm

INITIAL

at the scene: potential vertebral column injuries

ACUTE

osteoporotic fracture

non-osteoporotic fracture

Contributors

Authors

Besnik Nurboja, BSc, MBBS, MD (Res), MRCS, FRCEM

Consultant in Emergency Medicine

Emergency Medicine

Epsom and St Helier University Hospital NHS Trust

London

UK

Disclosures

BN declares that he has no competing interests.

David Choi, FRCS(SN)
David Choi

Consultant Neurosurgeon and Spinal Surgeon

The National Hospital for Neurology and Neurosurgery

London

UK

Disclosures

DC declares that he has no competing interests.

Peer reviewers

Nils Ake Nystrom, MD, PhD

Associate Professor

Department of Orthopedic Surgery and Rehabilitation

Division of Plastic and Reconstructive Surgery

University of Nebraska Medical Center

Omaha

NE

Disclosures

NAN is an author of a reference cited in this topic.

David W. Rowed, MD, FRCSC

Professor of Surgery

Division of Neurosurgery

University of Toronto

Physician

Department of Otolaryngology

Sunnybrook Health Sciences Centre

Toronto

Canada

Disclosures

DWR declares that he has no competing interests.

Renn Holness, BSC, MBBS (Hons), FRCSC

Professor

Division of Neurosurgery

Dalhousie University & QEII Health Sciences Centre

Halifax

Canada

Disclosures

RH declares that he has no competing interests.

Andre Tomasino, MD

Department of Neurological Surgery

Weill Cornell Medical College

New York-Presbyterian Hospital

New York

NY

Disclosures

AT declares that he has no competing interests.

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