UTILITY OF COMPUTED TOMOGRAPHY RECONSTRUCTED THORACOLUMBAR SPINAL IMAGING IN BLUNT TRAUMA.

Document Type

Article

Publication Date

7-1-2023

Abstract

OBJECTIVES: Fractures of the thoracolumbar(TL) spine are common and may cause neurologic damage, pain, and reduced quality of life. CT TL reconstructions from CT chest/abdomen/pelvis(CAP) are used to identify TL fractures, however their benefit over CAP imaging is unclear. We hypothesized that reformatted TL images do not identify additional clinically significant injuries or change outcomes.

METHODS: Retrospective data were collected 2016-2021 from trauma patients at a level-1 trauma center. All patients ≥18 years old, with TL fractures on CT CAP with/without CT TL reformats were included. Clinically significant TL fractures were defined as requiring operative fixation, brace, or spinal rehabilitation. A binary classification model was created to assess the diagnostic utility of CTCAP compared to CTTL in predicting clinically significant fractures in patients who underwent CT CAP/TL.

RESULTS: There were 828 patients with TL fractures, 634 had both CT CAP/CT TL (CAPTL) and 194CTCAP only (CAP). There were 134(16%) clinically significant TL fractures (14(7.2%) CT CAP vs120(18.9%) CT CAPTL,p < 0.001). There were no differences among unstable fractures, fractures on MRI only, mortality, or neurologic deficits on discharge between CAPTL and CAP(p > 0.05). Among clinically significant fractures, CAPTL was not associated with increased MRI utilization, surgery, spinal brace, or spinal cord rehabilitation(p > 0.05). Among clinically insignificant fractures, CAPTL was associated with increased MRIs, LOS, and ICU LOS (p < 0.05). CAPTL was also an independent predictor of increased MRIs (OR5.79,CI2.29-14.65,p < 0.01) and spine consultation (OR2.39,CI1.64-3.67,p < 0.01). More CTCAP/TL were performed in those with clinically significant fractures; however, CTCAP was equivalent to CTTL for detection of fractures(p > 0.05).

CONCLUSION: CTCAP alone is sufficient to identify clinically significant TL fractures. While the addition of TL reformatted imaging minimizes missed injuries, it is associated with increased hospital length of stay and MRI resource utilization. Therefore, careful consideration is needed for appropriate CT TL patient selection.

STUDY TYPE: Original Research.

LEVEL OF EVIDENCE: Level IV/Diagnostic Test.

Publication Title

J Trauma Acute Care Surg

Volume

95

Issue

1

First Page

116

Last Page

121

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