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A Clinical Decision Rule for Thoracic and Lumbar Spine Fractures: Does the NEXUS Rule Work Below the Neck?

The National Emergency X-Radiography Utilization Study (NEXUS) rule, which screens for potential cervical (C-) spine injury, suggests that imaging is not warranted in patients with no midline tenderness, no focal neurologic deficit, normal alertness, no intoxication, and no distracting injury. This rule has a reported sensitivity of 91-100% and specificity of 13-37% for clinically significant injuries. No prior studies have examined whether a variation of this rule might be useful for detecting thoracic (T-) and lumbar (L-) spine injuries. We sought to determine the value of a clinical decision rule based on NEXUS for detecting any injury, and any clinically significant injury, to the T- or…

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Articles of Interest

Evaluation of the Thoracic and Lumbar Spine in Blunt Trauma

Evaluation for injury of the cervical spine following blunt trauma was made much easier by the derivation and subsequent validation of key clinical decision rules (NEXUS criteria, Canadian c-spine rule). Unfortunately, no such rule exists for evaluation of the thoracic and lumbar spine.

Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures

Thoracolumbar spine is the most injured spinal region in blunt trauma... Thoracolumbar spine fractures occur in every 7/10 blunt trauma cases and make up to 9/10 of the spinal fractures recorded.

Lumbar Compression Fracture

Most of the fractures occur at the thoracolumbar junction. This is a transition zone (T12-L2): the thoracic vertebrae are more rigid in compare to the mobile lumbar region which means that the transition zone receives the biggest load during impacts.

Management of thoracolumbar spine trauma: An overview

Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery.

Thoracolumbar Burst Fractures

Thoracolumbar Burst Fractures are a common high-energy traumatic vertebral fractures caused by flexion of the spine that leads to a compression force through the anterior and middle column of the vertebrae leading to retropulsion of bone into the spinal canal and compression of the neural elements.

Thoracolumbar Spinal Injuries in Blunt Trauma...

TLS injuries are common in blunt trauma patients. Screening for these injuries is imperative owing to the devastating impact that unrecognized fractures and resultant spinal cord injuries can have on patient outcomes. The indications to scan patients with back pain, point tenderness, neurologic deficit, altered mental status, multiple or distracting injuries, or the presence of other spinal fractures are evident and well documented

Thoracolumbar Spine Fractures - Peds

Thoracolumbar spine trauma in pediatric patients is a rare entity. When it occurs, it can be potentially very devastating with a wide array of presentations. Treatment should be based on a strong understanding of the pediatric spine anatomy, biomechanics, and a thorough understanding of fracture pattern stability.

Thoracolumbar Spine Injuries Following Trauma, Identification of

It is clear from the literature that no imaging modality is accurate 100% of the time. Most studies have found that radiographs of the thoracolumbar spine (AP, lateral), are commonly inadequate, especially in obese patients, provided only a sensitivity and specificity of 60-70%. With the currently advances in computer tomography, plain films play only a limited part in the initial screening for thoracolumbar spine injuries.

Resources

StatPearls

The T10-L2 thoracolumbar region is the most common area of injury to the spine from trauma due to the specific biomechanics of this segment of the spine. Specifically, this is a transition area from the rigid and less mobile thoracic spine (due to the presence of the ribs which attach to the spine bilaterally) to a more flexible lumbar spine.