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Trauma da coluna toracolombar

Última revisão: 23 Sep 2025
Última atualização: 21 Jan 2025

Resumo

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
Full details

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
Full details

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
Full details

Diagnostic investigations

1st investigations to order

  • TC com multidetectores (TCMD) da coluna vertebral sem contraste
Full details

Investigations 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
Full details

Treatment algorithm

INITIAL

no local: possíveis lesões da coluna vertebral

ACUTE

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

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

Byron F. Stephens, MD, MSCI

Associate Professor

Vanderbilt University School of Medicine

Nashville

TN

利益声明

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.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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.全文

American College of Surgeons. Best practices guidelines. Spine injury. Mar 2022 [internet publication].全文

American College of Radiology. ACR appropriateness criteria: acute spinal trauma. 2024 [internet publication].全文

National Institute for Health and Care Excellence. Spinal injury: assessment and initial management. Feb 2016 [internet publication].全文

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.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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