Value of Digital Radiography in Acute Spinal Trauma. A Retrospective Analysis and Literature Review

Purpose: Spinal trauma is common and follows a spectrum of clinical presentation and severity that is nonlinear and hence provides a diagnostic challenge. The key to good radiologic practice is an accurate and timely diagnosis with an emphasis on good resource management and optimizing patient radiation dose.

Methods and Materials: A retrospective analysis was performed on spinal imaging performed on 842 trauma patients with a clinical concern for spinal injury referred from the emergency department at a busy tertiary referral center in Ireland over 3 years (2015–2018). A primary literature review of PubMed, Embase, and Medline for relevant articles was performed to identify current best practice guidelines for spinal trauma imaging.

Results: A total of 93% of the patients were initially referred for a plain radiograph as the first line of investigation. Overall, 23% of patients were referred for a second method of imaging and 18% for a third method of imaging. The diagnostic yield of plain radiographs is low. Average time to first-line imaging was 1.3 hours. The literature review revealed a debate about the optimal imaging strategy. Often the surgical team requires more than one imaging modality for surgical planning purposes.

Conclusion: Radiographs are a poor diagnostic tool overall in the management of spinal trauma. Mechanism of injury is an accurate predictor of injury severity and hence should guide selection of imaging technique.

No conflict of interest has been declared by the author(s).