Резюме
Определение
Анамнез и осмотр
Key diagnostic factors
- presencia de factores de riesgo
- anamnesis de traumatismos mecánicos
- historia clínica previa de osteoporosis o neoplasia
- dolor de espalda
- hematomas
- parestesia/entumecimiento agudo
- debilidad
- espasticidad muscular/clono (hipertonicidad) o hipotonía
- hiperreflexia o hiporreflexia
- signo de Hoffman
- signo de Babinski
- deformidad espinal
- pérdida del reflejo del esfínter anal
Other diagnostic factors
- ausencia del reflejo bulbocavernoso (S3-S4)
- signos de sección medular (hipotonía o flacidez que desaparecen dentro de las 24 horas)
- incontinencia urinaria
- retención urinaria indolora
Risk factors
- caída desde una altura
- mecanismo de lesión de alta energía
- edad >65 años
- osteoporosis concomitante
- fractura vertebral previa
- lesión neoplásica subyacente
- trastornos inflamatorios o metabólicos subyacentes
Diagnostic tests
1st tests to order
- TC multidetector sin contraste de la columna vertebral (TCMD)
Tests to consider
- radiografía de la columna toracolumbar (vistas anterior-posterior y lateral)
- imagen de resonancia magnética (IRM) de columna
- mielografía por TC
- IRM con secuencia STIR
- TC de cuerpo entero
Treatment algorithm
en la escena: lesiones en la columna vertebral posibles
fractura osteoporótica
fractura no osteoporótica
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)
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
Byron F. Stephens, MD, MSCI
Associate Professor
Vanderbilt University School of Medicine
Nashville
TN
Disclosures
BFS has received Institutional Research Support from Nuvasive and Stryker.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Wendt K, Nau C, Jug M, et al. ESTES recommendation on thoracolumbar spine fractures: January 2023. Eur J Trauma Emerg Surg. 2024 Aug;50(4):1261-75.Full text
American College of Surgeons. Best practices guidelines. Spine injury. Mar 2022 [internet publication].Full text
American College of Radiology. ACR appropriateness criteria: acute spinal trauma. 2024 [internet publication].Full text
National Institute for Health and Care Excellence. Spinal injury: assessment and initial management. Feb 2016 [internet publication].Full text
O'Toole JE, Kaiser MG, Anderson PA, et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: executive summary. Neurosurgery. 2019 Jan 1;84(1):2-6.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Dolor musculoesquelético en la zona lumbar
- Traumatismo agudo de la columna cervical
- Enfermedad degenerativa de columna cervical
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- Spinal injury: assessment and initial management
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