Thus, a burst fracture of the cervical region looks identical to that in the thoracic and lumbar regions ( Fig. The key to understanding this approach lies in the authors’ premise that all injuries due to a particular mechanism produce the same imaging changes regardless of the location. 2 This chapter will cover five areas: indicators of high risk for injury mechanisms of injury and their imaging “fingerprints” the ABCS or imaging “footprints” of injury the determination of stability following injury and the significance of injuries. Although at the present time, radiography is the procedure of choice for the thoracic and lumbar regions, the Harvard group at Massachusetts General Hospital report success with MDCT. 7, 16, 17 Therefore, once a decision has been made to perform imaging on any segment of the vertebral column for suspected injury, the entire spinal column should be examined. 1, 11– 15 Furthermore, our experience in our trauma center with a large trauma patient population, as well as that of other investigators has indicated that the incidence of noncontiguous, multi-level vertebral injuries is approximately 20%. 9, 10 CT has been shown to detect more fractures than radiography, in a faster and more cost-efficient manner. 6– 8 In many large medical centers within the United States, multi-detector computed tomography (MDCT) is replacing conventional radiography for evaluation of suspected cervical injury. 1– 5 Newer imaging options include the use of a low-dose digital radiography unit (Lodox Systems North America, South Lyon, MI) developed in South Africa and magnetic resonance imaging (MRI). It should be noted, however, that the approach to screening for suspected vertebral trauma has undergone a dramatic and sometimes controversial transition. Once a decision is made that imaging is indicated, radiography will generally be the first study performed. The indications and imaging options for evaluating patients with suspected vertebral trauma have been discussed in earlier chapters.
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