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Evaluation of the Lower Spine after Blunt Trauma Using Abdominal Computed Tomographic Scanning Supplemented with Lateral Scanograms

Gestring, Mark L. MD; Gracias, Vicente H. MD; Feliciano, M. A. MD; Reilly, Patrick M. MD; Shapiro, Michael B. MD; Johnson, Jon W. MD; Klein, Wendy MD; Kauder, Donald R. MD; Schwab, C. William MD

The Journal of Trauma: Injury, Infection, and Critical Care: July 2002 - Volume 53 - Issue 1 - p 9-14
Original Articles

Background  Patients at risk for thoracolumbar junction (TLJ) and lumbar spine (LS) injury after blunt trauma are classically evaluated using conventional radiographs. Frequently, these patients also undergo abdominal and pelvic computed tomographic (CT) scanning to exclude the presence of associated intra-abdominal injuries. Standard abdominal and pelvic CT scan usually includes an anteroposterior (AP) scout film (scanogram) obtained before the cross-sectional imaging. The objective of this study was to determine whether a lateral CT scanogram and axial CT views would provide adequate imaging to allow for evaluation of the TLJ and LS and therefore eliminate the need for conventional screening computed lumbar spine radiographs (CLSRs).

Methods  Patients who sustained blunt injury and required both CLSRs as well as abdominal and pelvic CT scans were prospectively identified. The study protocol (CT + S) added lateral CT scanograms to all helical abdominal and pelvic CT scan studies. The AP and lateral CT scanograms were included with the axial images, and these views were reviewed together during final radiographic interpretation and diagnosis. The results of CT + S were compared with readings of the CLSRs (AP and lateral) in a blinded fashion by a trauma radiologist.

Results  Lateral scanograms were generated for 71 patients. All scanograms were technically adequate, with image quality equal or superior to computed plain radiographs. Ten patients were found to have 20 fractures, 19 acute and 1 chronic. All abnormalities identified by plain radiographs were seen using CT + S (sensitivity, 100%; specificity, 100%). Eight transverse process and two spinous process fractures not seen on CLSRs were identified using CT + S.

Conclusion  Our CT + S protocol (axial CT images plus AP and lateral scanograms) outperformed screening CLSRs in the detection of fractures of the lower spine (TLJ + LS) after blunt trauma. In addition, scanogram imaging is less dependent on body habitus and adds no additional cost or time to abdominal and pelvic CT scanning. Further study is required to determine whether CT + S can routinely replace conventional radiographs of the lower spine after blunt trauma.

From the Department of Surgery, Division of Traumatology and Surgical Critical Care (M.L.G, V.H.G., P.M.R., M.B.S., J.W.J., D.R.K., C.W.S.), and Department of Radiology (M.A.F., W.K.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Submitted for publication May 15, 2001.

Accepted for publication March 7, 2002.

Presented at the 31st Annual Meeting of the Western Trauma Association, February 24–March 1, 2001, Big Sky, Montana.

Address for reprints: Vicente H. Gracias, MD, Division of Traumatology and Surgical Critical Care, University of Pennsylvania Health System, 3440 Market Street, 1st Floor, Philadelphia, PA 19104-3335; email:

© 2002 Lippincott Williams & Wilkins, Inc.