A HIGH-RISK GROUP FOR THORACOLUMBAR FRACTURES

Unconscious patients with multiple injuries present a major diagnostic and therapeutic problem. The incidence of neurological deficit increa ses if diagnosis of a spinal injury is delayed or missed. Thoracolumba r fractures are commonly the result of high energy injuries and in an unconscious patient the risk of missing such fractures is increased co nsiderably There is little consensus on which blunt trauma patients wa rrant thoracolumbar spine films when no pain, tenderness, neurological deficit or cervical spine injuries are identified. We present a retro spective analysis of all patients who were admitted to the Major Injur ies Unit at the Birmingham General Hospital and underwent radiological survey of the thoracolumbar spine. Of the 110 patients, all spinal fr actures were defected in 94 patients with a Glasgow Coma Scale (GCS) g reater than or equal to 11. Of the 16 with a GCS less than or equal to 10, 9 patients had sustained injuries of their thoraco-lumbar spine 4 of which were not detected initially due to a decreased level of cons ciousness. The common features amongst the 4 patients with missed inju ries were: (1) High velocity injury. (2) Decreased level of consciousn ess on admission. (3) Associated head injury. (4) Pelvis/lower extremi ty injury. We describe the four cases and identify a group of high ris k patients for thoracolumbar fractures. Radiological examination of th e thoracolumbar spine is essential in this group. (C) 1998 Published b y Elsevier Science Ltd. All rights reserved.