Thoracic Spine Fractures and Dislocations Workup

Updated: Oct 07, 2020
  • Author: Brian J Page, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
  • Print
Workup

Imaging Studies

Radiography

Anteroposterior (AP) and lateral radiographs of the thoracic spine can be obtained initially as part of the evaluation when a spine fracture is suspected; however, most centers proceed with computed tomography (CT), if available, when a spine fracture is suspected. Radiographic evidence of a fracture at any level of the spine warrants radiographic analysis of the entire spine, particularly in high-energy injuries, to evaluate for noncontiguous injury. [17]

Computed tomography

CT of the thoracic spine with sagittal reformatted images provides information about the extent of injury to osseous structures and posterior elements. [18] Smith et al found that nonreconstructed abdomen and pelvis CT detected thoracolumbar spine fractures more accurately than plain radiography did and recommended CT for diagnosis of such fractures in acute trauma patients with altered mental status. [19] Although many centers will obtain dedicated spine films, Imran et al showed that CT of the chest, abdomen, and pelvis did not miss clinically significant fractures. [20]

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is useful for evaluating soft-tissue injury to the ligaments, disks, and epidural spaces. [21, 22] MRI is most useful in cases where traumatic disk herniation, epidural hematoma, or spinal cord injury (SCI) is suspected. In addition, MRI is used when CT and radiographic analysis do not adequately explain the patient's symptoms or neurologic findings. [23]