eMedicine Specialties > Radiology > Musculoskeletal

Thoracic Spine, Trauma: Follow-up

Author: Lennard A Nadalo, MD, Clinical Professor, Department of Radiology, University of Texas Southwestern Medical School; Consulting Staff, Envision Imaging of Allen and Radiological Consultants Association
Coauthor(s): James A Moody, MD, Chief, Neurosurgery Section, Department of Surgery, Methodist Medical Center
Contributor Information and Disclosures

Updated: Mar 23, 2007

Intervention

Primary intervention in thoracic spinal fractures is unusual. Occasionally, the placement of a lumbar spine drainage catheter improves the likelihood of primary closure of a dural tear in the thoracic area. Intraoperative radiography provides important information that may require consultation in the operating room between the radiologist and the surgeon. A pleural effusion may need to be drained in patients with chest wall trauma. Thoracentesis is most easily performed by using ultrasonographic guidance.

Flexion-extension maneuvers are well within the normal range of motion of most patients with spinal fusion. After the initial period of healing of 12-24 weeks, moderate flexion-extension movements are safe. Instability and subluxation indicate a primary failure of the fusion surgery.

Medicolegal Pitfalls

  • The primary legal pitfall is the failure to diagnose an injury that later may result in neurologic deficits that prompt diagnosis and treatment may have prevented.
  • Key elements in avoiding legal pitfalls involve prompt correct interpretation of the initial spinal radiographs with direct communication of important results to the treating physician.
    • Comparison of the current studies with prior thoracic spinal imaging studies may further enhance the understanding of the current medical problem.
    • The direct recommendation for repeated or more advanced imaging (eg, MRI or nuclear medicine studies) has been increasingly emphasized in recent court decisions.
 


More on Thoracic Spine, Trauma

Overview: Thoracic Spine, Trauma
Imaging: Thoracic Spine, Trauma
Follow-up: Thoracic Spine, Trauma
Multimedia: Thoracic Spine, Trauma
References
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References

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  17. Wheeless. Wheeless' Textbook of Orthopaedics. Available at: http://www.medmedia.com/. Accessed January 18, 2002. [Full Text].

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Further Reading

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Keywords

Chance fracture, spinal compression fracture, burst fracture, thoracic trauma, thoracic fracture, spinal fractures, seatbelt injury, thoracic fracture-dislocation, Denis classification, Denis fractures

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Contributor Information and Disclosures

Author

Lennard A Nadalo, MD, Clinical Professor, Department of Radiology, University of Texas Southwestern Medical School; Consulting Staff, Envision Imaging of Allen and Radiological Consultants Association
Lennard A Nadalo, MD is a member of the following medical societies: American College of Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Radiological Society of North America, and Texas Radiological Society
Disclosure: Nothing to disclose.

Coauthor(s)

James A Moody, MD, Chief, Neurosurgery Section, Department of Surgery, Methodist Medical Center
James A Moody, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Michael A Bruno, MD, Associate Professor, Departments of Radiology and Medicine, Pennsylvania State University College of Medicine; Director, Radiology Quality Management Services, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine
Michael A Bruno, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Theodore E Keats, MD, Professor, Departments of Radiology and Orthopedics, University of Virginia School of Medicine
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, EdM, MBA, Professor, Department of Radiology, Section Head of Musculoskeletal Radiology, Vice Chairman for Radiology Informatics, University of Washington
Felix S Chew, MD, EdM, MBA is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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