ACR Appropriateness Criteria® on Suspected Spine Trauma

The evaluation of patients with suspected spine trauma is controversial. This document addresses several pertinent issues: (1) which patients need imaging, (2) how much imaging is necessary, and (3) exactly what sort of imaging is to be performed. This subject is important, because conservative estimates indicate that more than 1 million blunt trauma patients, who have the potential for sustaining spine injuries, are seen annually in emergency departments in the United States. Adult patients who satisfy any of several “low-risk” criteria for cervical spine injury need no imaging. Patients who do not fall into this category should undergo thin-section computed tomographic examinations that includes sagittal and coronal multiplanar reconstructed images. For those patients who cannot be examined using computed tomography, 3-view radiographic examinations of the cervical vertebrae may be performed to provide preliminary assessments of the likelihood of injury until computed tomography can be performed. Thoracic and lumbar computed tomographic images may be obtained from data collected for thorax-abdomen-pelvis studies. Radiography is recommended for children under 14 years of age. Reconstructed computed tomographic images may be used from thorax-abdomen-pelvis studies of children, if they have been obtained. Magnetic resonance imaging should be the primary modality for evaluating possible spinal cord injury or compression as well as ligamentous injuries in acute cervical spine trauma. Flexion and extension radiography is best reserved for follow-up of symptomatic patients, after neck pain has subsided.