DO LUMBAR TRAUMA RADIOGRAPHS ALLOW ADEQUATE VISUALISATION FOR FRACTURE DIAGNOSIS IN CLINICAL PRACTICE?

Abstract

Guidelines for cervical trauma x-rays highlight the necessity for visualization of the C7-T1 junction. However, despite 15% of thoracolumbar fractures involving the T12 vertebra, less emphasis has been placed on ensuring the thoracolumbar junction or T12 vertebra is included on lumbar trauma radiographs. This may be due to an assumption that the lower thoracic spine will routinely be seen on lumbar x-rays.

We aimed to determine the proportion of lumbar trauma x-rays that allowed adequate visualisation for fracture diagnosis. We retrospectively reviewed all lumbar spine radiographs for patients presenting with blunt trauma to the Victoria Infirmary, Glasgow from January 2007 to January 2009. Our criteria for an appropriate lumbar trauma x-ray were that the whole lumbar spine should be visualized as well as the whole T12 vertebra.

From 583 lumbar radiographs reviewed, 61 (10%) did not fulfill the criteria for an acceptable lumbar trauma x-ray. 3% did not include the lumbrosacral junction and 7% did not include the T12 vertebra. One patient had a delayed diagnosis of a T12 fracture due to incomplete visualisation of the T12 vertebra on initial lumbar radiographs.

A significant proportion of lumbar spine x-rays performed for trauma patients (up to 10%) may not allow adequate visualisation for fracture diagnosis. These x-rays may give false reassurance that no fracture is present and, in turn, may lead to potentially disabling consequences. Spinal imaging for trauma patients should be interpreted closely with clinical findings. In cases where there is difficulty visualising the lumbar spine appropriately with radiographs, a CT scan should be considered.