From the Guidelines
For thoracic spine trauma, CT chest is the preferred imaging modality over plain radiographs. This recommendation is based on the most recent and highest quality study, which reported that CT outperforms radiographs in the diagnosis of thoracolumbar spine fractures, with a sensitivity of 94% to 100% for CT compared to 49% to 62% for radiographs 1. The use of CT scans provides superior visualization of the thoracic spine, offering detailed three-dimensional images that can detect fractures, dislocations, and soft tissue injuries that might be missed on plain films.
When evaluating a patient with suspected thoracic spine trauma, a contrast-enhanced CT scan should be obtained promptly, particularly in the setting of high-energy mechanisms such as motor vehicle accidents, falls from height, or direct trauma to the back. Plain films have limited sensitivity due to overlapping structures and the complex anatomy of the thoracic region. CT scanning offers much higher sensitivity and can simultaneously evaluate for associated injuries to the lungs, great vessels, and other thoracic structures that frequently accompany spine trauma.
Some key points to consider when evaluating thoracic spine trauma include:
- The clinical significance of fractures missed on radiographs is uncertain, but the use of CT scans can help identify these injuries 1.
- MRI may be indicated as a complementary study if there is concern for spinal cord injury, ligamentous injury, or disc herniation, but CT remains the initial imaging modality of choice for bony injuries in acute thoracic trauma.
- The use of reformats from a CT of the chest/abdomen/pelvis (CT-CAP) is superior to plain imaging for detecting thoracolumbar spine fractures 1.
Overall, the use of CT chest is the preferred imaging modality for evaluating thoracic spine trauma due to its high sensitivity and ability to detect associated injuries.
From the Research
Imaging Modalities for Thoracic Spine Trauma
- Computed Tomography (CT) is a highly sensitive modality for detecting thoracic spine fractures, especially when reformatted images are used 2.
- Multidetector CT (MDCT) is the most important modality for diagnosing polytrauma patients due to its broad availability and higher sensitivity 3.
- Radiography has low sensitivity but high specificity for detecting vertebral body fractures, and its use is limited in patients with neurological deficits, upper extremity injuries, or elderly patients 4.
Diagnostic Protocol for Thoracic Spine Trauma
- A CT examination, including the whole thoracic cage, is recommended for diagnosing thoracic vertebral body fractures, especially in patients with high-energy accidents or clinical suspicion of concomitant thoracic injuries 5.
- The Spinal Cord Society recommends CT without contrast as the initial line of imaging for cervical and thoracolumbar spine trauma patients, with radiographs required if CT is unavailable or unaffordable 6.
- MRI is indicated in cases with neurological involvement, advanced cervical degenerative changes, or to determine the extent of soft tissue injury 6.
Comparison of Imaging Modalities
- Reformatting of CT scans improves sensitivity in detecting thoracic and lumbar spine fractures 2.
- MDCT is more sensitive than radiography in detecting unstable fractures, especially in patients with upper extremity injuries or aged 65 years or older 4.
- CT screening in polytrauma cases is best done with a multidetector CT by utilizing the reformatted images obtained when scanning the chest, abdomen, and pelvis (CT-CAP) 6.