Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- história de trauma mecânico
- história médica pregressa de osteoporose ou neoplasia
- dorsalgia
- hematomas
- dormência aguda/parestesia
- fraqueza
- espasticidade/clônus (hipertonicidade) ou hipotonia muscular
- hiper-reflexia ou hiporreflexia
- sinal de Hoffman
- sinal de Babinski positivo
- deformidade espinhal
- perda do reflexo do esfíncter anal
Other diagnostic factors
- ausência de reflexo bulbocavernoso (S3-S4)
- sinais de choque medular (hipotonia ou flacidez que remite em até 24 horas)
- incontinência urinária
- retenção urinária indolor
Risk factors
- queda de uma altura
- mecanismo de lesão de alta energia
- idade >65 anos
- osteoporose concomitante
- fratura vertebral prévia
- lesão neoplásica subjacente
- distúrbios metabólicos ou inflamatórios subjacentes
Diagnostic tests
1st tests to order
- TC com multidetectores (TCMD) da coluna vertebral sem contraste
Tests to consider
- radiografia da coluna toracolombar (imagens anteroposterior e lateral)
- RNM da coluna vertebral
- mielotomografia
- RNM com sequência STIR (short-tau inversion recovery - recuperação de inversão com tau curto)
- TC do corpo inteiro
Treatment algorithm
no local: possíveis lesões da coluna vertebral
fratura osteoporótica
fratura não 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
Declarações
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
Declarações
DC declares that he has no competing interests.
Revisores
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
- Dor musculoesquelética na coluna lombar
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