drjanak
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Diagnosis of spinal injury
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07.14.08 (2 months ago)
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Sabiston Textbook of Surgery, 18th ed. Ch 21 – Emergency care of Musculoskeletal injuries
Patient Evaluation
Diagnostic Imaging In a multiply injured patient, the advanced trauma life support protocol calls for a lateral cervical spine film and anteroposterior views of the pelvis and chest.
In complex intra-articular fractures, a CT scan is usually necessary to fully understand the position and displacement of all articular fragments. CT scans provide fine detail, help locate small fragments in the joint, and can further describe the extension of intra-articular fracture lines. They must not be used in lieu of acceptable plain radiographs, however. Plain radiographs are better suited to accurately describe overall fracture characteristics and limb alignment.
Additional imaging is undertaken in specific circumstances only after acceptable plain radiographs have been thoroughly reviewed.
Magnetic resonance imaging (MRI) has become a particularly useful imaging modality. It is used to evaluate soft tissue, acute fractures, stress fractures, spinal cord injuries, and intra-articular Pathology
. Its role in the trauma setting has expanded as well, and it is particularly helpful in the setting of spinal cord injury
Schwartz's Surgery 8th Ed Ch.42> Orthopedics> Spinal Injuries
A lateral cervical spine radiograph is part of the initial "trauma series" that is obtained on all multitrauma patients (Fig. 42-65). The radiograph must include the entire cervical spine from the occiput to the first thoracic vertebra. Inability to obtain a proper lateral radiograph necessitates additional views, such as swimmer's view, to visualize the lower cervical spine or a CT scan. Other views of the cervical spine that should be obtained after the patient is sufficiently resuscitated and stabilized are the AP and open-mouth odontoid views. Anteroposterior, lateral thoracic spine, and lumbar spine radiographs are obtained in all unconscious or mentally-impaired patients, and in conscious, alert patients with pain and/or tenderness in those regions.
Most injuries are adequately seen on plain radiographs, but CT scans are often used to better appreciate the details of the bone fragments (Fig. 42-66). For patients with neurologic injury an MRI is useful because the spinal cord and soft tissues within the canal can be visualized (Fig. 42-67).
The answer should be X-rays in a patient with trauma. Once established as a fracture, CT evaluation maybe useful for the details of the fracture. You are right a spinal cord injury should be evaluated with a MRI but I think the question here is “spinal injury” and not “spinal cord injury”. So MRI should be a later investigation.
I have not come across any mention of Myelography hence it looks like an incorrect answer.
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