Korean J Radiol.  2019 Jun;20(6):909-915. 10.3348/kjr.2018.0792.

Primary Imaging Test for Suspected Traumatic Thoracolumbar Spine Injury: 2017 Guidelines by the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

Affiliations
  • 1Department of Radiology, Chung-Ang University Hospital, Seoul, Korea.
  • 2Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, Korea. mshjy@ewha.ac.kr
  • 3Department of Radiology, Gunkuk University Hostpial, Seoul, Korea.
  • 4Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 5Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
  • 6Department of Radiology, Ajou University School of Medicine, Suwon, Korea.
  • 7Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed a primary imaging test for suspected traumatic thoracolumbar spine injury. This guideline was developed using an adaptation process involving collaboration between the development committee and the working group. The development committee, consisting of research methodology experts, established the overall plan and provided support on research methodology. The working group, composed of radiologists with expertise in musculoskeletal imaging, wrote the recommendation. The guidelines recommend that thoracolumbar spine computed tomography without intravenous contrast enhancement be the first-line imaging modality for diagnosing traumatic thoracolumbar spine injury in adults.

Keyword

Spine; Injury; Trauma; Guideline; Radiography; Computed tomography; Magnetic resonance imaging

MeSH Terms

Adult
Cooperative Behavior
Evidence-Based Practice*
Humans
Magnetic Resonance Imaging
Radiography
Research Design
Spine*

Figure

  • Fig. 1 Flow diagram of guideline selection (key question).GIN = Guideline International Network, KoMGI = Korean Medical Guidelines, NGC = National Guideline Clearinghouse


Reference

1. Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976). 1992; 17:528–540. PMID: 1621152.
2. Gertzbein SD, Khoury D, Bullington A, St John TA, Larson AI. Thoracic and lumbar fractures associated with skiing and snowboarding injuries according to the AO comprehensive classification. Am J Sports Med. 2012; 40:1750–1754. PMID: 22700890.
Article
3. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994; 3:184–201. PMID: 7866834.
Article
4. Kraemer WJ, Schemitsch EH, Lever J, McBroom RJ, McKee MD, Waddell JP. Functional outcome of thoracolumbar burst fractures without neurological deficit. J Orthop Trauma. 1996; 10:541–544. PMID: 8915916.
Article
5. Moutinho R, Tyrrell P, Cassar-Pullicino VN. Emergency and trauma imaging of the thoracolumbar spine. Semin Musculoskelet Radiol. 2017; 21:199–209. PMID: 28571085.
Article
6. Ballock RT, Mackersie R, Abitbol JJ, Cervilla V, Resnick D, Garfin SR. Can burst fractures be predicted from plain radiographs? J Bone Joint Surg Br. 1992; 74:147–150. PMID: 1732246.
Article
7. Hauser CJ, Visvikis G, Hinrichs C, Eber CD, Cho K, Lavery RF, et al. Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. J Trauma. 2003; 55:228–234. discussion 234–235. PMID: 12913630.
Article
8. Wintermark M, Mouhsine E, Theumann N, Mordasini P, van Melle G, Leyvraz PF, et al. Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. Radiology. 2003; 227:681–689. PMID: 12702827.
Article
9. Pizones J, Zúñiga L, Sánchez-Mariscal F, Alvarez P, Gómez-Rice A, Izquierdo E. MRI study of post-traumatic incompetence of posterior ligamentous complex: importance of the supraspinous ligament. Prospective study of 74 traumatic fractures. Eur Spine J. 2012; 21:2222–2231. PMID: 22722921.
Article
10. Pizones J, Izquierdo E, Alvarez P, Sánchez-Mariscal F, Zúñiga L, Chimeno P, et al. Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment. Eur Spine J. 2011; 20(Suppl 3):390–396. PMID: 21779855.
Article
11. Choi SJ, Jeong WK, Jo AJ, Choi JA, Kim MJ, Lee M, et al. Methodology for developing evidence-based clinical imaging guidelines: joint recommendations by Korean Society of Radiology and National Evidence-based Healthcare Collaborating Agency. Korean J Radiol. 2017; 18:208–216. PMID: 28096730.
Article
12. Steering Committee for Clinical Practice Guideline. Korean appraisal of guidelines for research & evaluation II. The AGREE next steps consortium, 2009. Accessed March 1, 2017. Available at: http://www.agreetrust.org/wp-content/uploads/2013/06/AGREE_II_Korean.pdf.
13. Roth CJ, Angevine PD, Aulino JM, Berger KL, Choudhri AF, Fries IB, et al. ACR appropriateness criteria myelopathy. J Am Coll Radiol. 2016; 13:38–44. PMID: 26653797.
Article
14. Daffner RH, Hackney DB. ACR Appropriateness Criteria® on suspected spine trauma. J Am Coll Radiol. 2007; 4:762–775. PMID: 17964500.
Article
15. National Clinical Guideline Centre (UK). Spinal injury: assessment and initial management. London: National Institute for Health and Care Excellence;2016.
16. Chang CH, Holmes JF, Mower WR, Panacek EA. Distracting injuries in patients with vertebral injuries. J Emerg Med. 2005; 28:147–152. PMID: 15707808.
Article
17. Dai LY, Yao WF, Cui YM, Zhou Q. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma. 2004; 56:348–355. PMID: 14960979.
Article
18. Hsu JM, Joseph T, Ellis AM. Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury. 2003; 34:426–433. PMID: 12767788.
Article
19. Brown CV, Antevil JL, Sise MJ, Sack DI. Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: its time has come. J Trauma. 2005; 58:890–895. discussion 895–896. PMID: 15920398.
Article
20. Berry GE, Adams S, Harris MB, Boles CA, McKernan MG, Collinson F, et al. Are plain radiographs of the spine necessary during evaluation after blunt trauma? Accuracy of screening torso computed tomography in thoracic/lumbar spine fracture diagnosis. J Trauma. 2005; 59:1410–1413. discussion 1413. PMID: 16394914.
Article
21. Brandt MM, Wahl WL, Yeom K, Kazerooni E, Wang SC. Computed tomographic scanning reduces cost and time of complete spine evaluation. J Trauma. 2004; 56:1022–1026. discussion 1026–1028. PMID: 15179241.
Article
22. Herzog C, Ahle H, Mack MG, Maier B, Schwarz W, Zangos S, et al. Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy? Eur Radiol. 2004; 14:1751–1760. PMID: 15300395.
Article
23. Lucey BC, Stuhlfaut JW, Hochberg AR, Varghese JC, Soto JA. Evaluation of blunt abdominal trauma using PACS-based 2D and 3D MDCT reformations of the lumbar spine and pelvis. AJR Am J Roentgenol. 2005; 185:1435–1440. PMID: 16303994.
Article
24. Sheridan R, Peralta R, Rhea J, Ptak T, Novelline R. Reformatted visceral protocol helical computed tomographic scanning allows conventional radiographs of the thoracic and lumbar spine to be eliminated in the evaluation of blunt trauma patients. J Trauma. 2003; 55:665–669. PMID: 14566120.
Article
25. van Beek EJ, Been HD, Ponsen KK, Maas M. Upper thoracic spinal fractures in trauma patients - a diagnostic pitfall. Injury. 2000; 31:219–223. PMID: 10719098.
Article
26. Dai LY, Wang XY, Jiang LS, Jiang SD, Xu HZ. Plain radiography versus computed tomography scans in the diagnosis and management of thoracolumbar burst fractures. Spine (Phila Pa 1976). 2008; 33:E548–E552. PMID: 18628696.
Article
27. Karul M, Bannas P, Schoennagel BP, Hoffmann A, Wedegaertner U, Adam G, et al. Fractures of the thoracic spine in patients with minor trauma: comparison of diagnostic accuracy and dose of biplane radiography and MDCT. Eur J Radiol. 2013; 82:1273–1277. PMID: 23422283.
Article
28. Campbell SE, Phillips CD, Dubovsky E, Cail WS, Omary RA. The value of CT in determining potential instability of simple wedge-compression fractures of the lumbar spine. AJNR Am J Neuroradiol. 1995; 16:1385–1392. PMID: 7484620.
29. Krueger MA, Green DA, Hoyt D, Garfin SR. Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop Relat Res. 1996; (327):191–195. PMID: 8641063.
Article
30. Rhea JT, Sheridan RL, Mullins ME, Novelline RA. Can chest and abdominal trauma CT eliminate the need for plain films of the spine? - Experience with 329 multiple trauma patients. Emergency Radiology. 2001; 8:99–104.
Article
31. Rhee PM, Bridgeman A, Acosta JA, Kennedy S, Wang DS, Sarveswaran J, et al. Lumbar fractures in adult blunt trauma: axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films. J Trauma. 2002; 53:663–667. discussion 667. PMID: 12394863.
Article
32. Gestring ML, Gracias VH, Feliciano MA, Reilly PM, Shapiro MB, Johnson JW, et al. Evaluation of the lower spine after blunt trauma using abdominal computed tomographic scanning supplemented with lateral scanograms. J Trauma. 2002; 53:9–14. PMID: 12131382.
Article
33. Inaba K, Munera F, McKenney M, Schulman C, de Moya M, Rivas L, et al. Visceral torso computed tomography for clearance of the thoracolumbar spine in trauma: a review of the literature. J Trauma. 2006; 60:915–920. PMID: 16612322.
Article
34. Salim A, Sangthong B, Martin M, Brown C, Plurad D, Demetriades D. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg. 2006; 141:468–473. discussion 473–475. PMID: 16702518.
35. Mancini DJ, Burchard KW, Pekala JS. Optimal thoracic and lumbar spine imaging for trauma: are thoracic and lumbar spine reformats always indicated? J Trauma. 2010; 69:119–121. PMID: 20622586.
Article
36. Smith MW, Reed JD, Facco R, Hlaing T, McGee A, Hicks BM, et al. The reliability of nonreconstructed computerized tomographic scans of the abdomen and pelvis in detecting thoracolumbar spine injuries in blunt trauma patients with altered mental status. J Bone Joint Surg Am. 2009; 91:2342–2349. PMID: 19797568.
Article
37. Daffner RH, Sciulli RL, Rodriguez A, Protetch J. Imaging for evaluation of suspected cervical spine trauma: a 2-year analysis. Injury. 2006; 37:652–658. PMID: 16504194.
Article
38. Hogan GJ, Mirvis SE, Shanmuganathan K, Scalea TM. Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal? Radiology. 2005; 237:106–113. PMID: 16183927.
Article
39. Benzel EC, Hart BL, Ball PA, Baldwin NG, Orrison WW, Espinosa MC. Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. J Neurosurg. 1996; 85:824–829. PMID: 8893720.
Article
40. Davis SJ, Khangure MS. A review of magnetic resonance imaging in spinal trauma. Australas Radiol. 1994; 38:241–253. PMID: 7993244.
Article
41. O'Beirne J, Cassidy N, Raza K, Walsh M, Stack J, Murray P. Role of magnetic resonance imaging in the assessment of spinal injuries. Injury. 1993; 24:149–154. PMID: 8509179.
42. Silberstein M, Tress BM, Hennessy O. A comparison between M.R.I. and C.T. in acute spinal trauma. Australas Radiol. 1992; 36:192–197. PMID: 1445100.
Article
43. Tracy PT, Wright RM, Hanigan WC. Magnetic resonance imaging of spinal injury. Spine (Phila Pa 1976). 1989; 14:292–301. PMID: 2711244.
Article
44. Pizones J, Sánchez-Mariscal F, Zúñiga L, Álvarez P, Izquierdo E. Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine. Spine (Phila Pa 1976). 2013; 38:745–775. PMID: 23089929.
Article
45. Tarr RW, Drolshagen LF, Kerner TC, Allen JH, Partain CL, James AE Jr. MR imaging of recent spinal trauma. J Comput Assist Tomogr. 1987; 11:412–417. PMID: 3571580.
Article
Full Text Links
  • KJR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr