Can Motor Vehicle Accidents Cause Thoracic Radiculopathy?
Yes, motor vehicle accidents can cause thoracic radiculopathy, though this is an uncommon injury pattern that is frequently overlooked and often takes months to years to diagnose. 1, 2
Mechanism of Injury in Motor Vehicle Accidents
Motor vehicle accidents cause thoracic radiculopathy through several distinct mechanisms:
- Direct trauma from high-energy mechanisms such as MVAs can result in thoracic spine fractures, disc herniations, and ligamentous injuries that compress nerve roots 1
- Symptomatic thoracic disc herniations are associated with a history of trauma in more than one-third of patients, and these herniations are often calcified (20-65% of cases) 1
- Hyperextension injuries from rear-end collisions can stretch and damage paraspinal structures, though this mechanism more commonly affects the cervical region 3, 4
- Blunt thoracic trauma accounts for one-quarter of traumatic deaths and can cause vertebral fractures with foraminal stenosis that develops over time 1
Clinical Presentation and Diagnostic Challenges
Thoracic radiculopathy presents with thoracic or abdominal pain that radiates in a dermatomal distribution, often with sensory deficits at the affected level. 1, 5
Key diagnostic considerations include:
- The clinical presentation is often atypical, leading to delayed diagnosis for months or years after symptom onset 5, 2
- Thoracic radiculopathy is most commonly due to mechanical nerve root compression from degenerative, metabolic, infectious, or neoplastic causes, but trauma is a recognized etiology 1
- MRI thoracic spine without IV contrast is the initial imaging modality of choice when myelopathy or radiculopathy is suspected, as it directly visualizes nerve root compression 1, 6
- Electromyography can be useful in confirming the diagnosis and localizing the level of involvement 2
Prevalence and Risk Factors
- Thoracic spine injuries occur in an estimated 4-7% of patients presenting to emergency departments with blunt trauma 1
- An increasing rate of thoracolumbar spine fractures has been observed despite declining motor vehicle-related injuries overall, likely due to increased detection and seatbelt-related injury patterns 1
- 20% of spine trauma patients have noncontiguous injuries at multiple levels, requiring full spine imaging when any level is injured 7, 6
Critical Pitfalls to Avoid
Plain radiographs and CT scans can miss purely ligamentous injuries and nerve root compression that are only visible on MRI. 7, 6
Specific concerns include:
- Up to 25% of cervical spine injuries involve no fracture but represent unstable ligamentous injuries invisible on plain films and CT, and similar patterns can occur in the thoracic spine 7, 6
- Normal CT does not exclude significant injury in patients with neurological symptoms, as cord contusions and ligamentous disruptions require MRI for visualization 7, 6
- Thoracic radiculopathy should be considered in the differential diagnosis of any patient with thoracic or abdominal pain following trauma, especially if initial diagnostic studies are inconclusive 5
Treatment Approach
- Conservative management is typically attempted first for thoracic radiculopathy 2, 8
- Surgical intervention is usually reserved for patients with progressive myelopathy, neurologic compromise, or severe intractable pain that fails conservative treatment 1, 2
- Long-term outcomes vary significantly, with only 47% of surgically treated patients and 20% of conservatively treated patients experiencing very good pain relief in one trauma series 4