Category: Orthopedics
Keywords: Spine, Fracture, Diagnosis (PubMed Search)
Posted: 2/20/2010 by Michael Bond, MD
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A recent study by Smith et al showed that the general abdomen/pelvic CT scan in trauma patients obtained with 5mm slices is a better screening test for spine fractures than plain films. They also showed that when compared to dedicated reconstructed thoracolumbar CT scan (2mm slices focused on the spine) it did not miss any clinically significant fractures.
The statistic for plain radiographs and the nonreconstructive CT scan are shown below.
| | Plain Radiographs | Nonreconstructive CT Scan | ||
| | Lumbar | Thoracic | Lumbar | Thoracic |
| Sensitivity % [95% CI] | 47 [33 to 62] | 13 [3 to 32] | 94 [83 to 99] | 73 [50 to 89] |
| Specificity % [95% CI] | 91 [78 to 97] | 71 [54 to 85] | 95 [85 to 99] | 94 [79 to 99] |
| Positive Predictive Value % [95% CI] | 85 [66 to 96] | 15 [2 to 45] | 95 [86 to 99] | 89 [67 to 99] |
| Negative Predictive Value % [95% CI] | 61 [48 to 72] | 56 [41 to 71] | 93 [82 to 99] | 83 [66 to 93] |
The take home point is that dedicated Spine CT scans are probably not needed unless they are going to be used to guide surgical or non-surgical management, and plain films should probably be abandoned in patients that are undergoing CT scans of the chest/abdomen/pelvis.
Smith MW, Reed JD, Facco R, Hlaing T, McGee A, Hicks BM, Aaland M: The reliability of nonreconstructed computerized tomographic scans of the abdomen and pelvis in detecting thoracolumbar spine injuries in blunt trauma patients with altered mental status. J Bone Joint Surg Am 2009; 91: 2342-2349.
