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Clinical Decisionmaking

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Six percent of blunt trauma patients seen in the ER have injuries to the thoracolumbar spine

About 6 percent of more than 2,400 blunt trauma patients seen at a trauma center over the course of a year who had x-rays of the thoracolumbar (TL) spine had injuries to that area. The most common site of injury in this study was the thoracolumbar junction. Nearly half (44 percent) of patients with an injury of one thoracolumbar vertebra also had a second injury, and a third of patients with multiple injuries had discrete (noncontiguous) injuries. Therefore, emergency department doctors who see one injury to the TL spine should carefully search for other injuries, not only near the site of the initially identified injury, but throughout the entire TL spine, suggests principal investigator William R. Mower, M.D., Ph.D., of the University of California, Los Angeles School of Medicine.

In a study that was supported in part by the Agency for Healthcare Research and Quality (HS08239), Dr. Mower and his colleagues evaluated the prevalence, distribution, and demographics of TL spine injuries among 2,404 blunt trauma patients who underwent TL spinal x-rays at one trauma center. The thoracolumbar junction—the transition zone from thoracic to lumbar vertebrae and a fragile area for several reasons—was the most common site of injuries. Among the 6.3 percent of patients with vertebral injuries, 16.2 percent occurred at lumbar vertebra 1 (L1), 14.6 percent at L2, 11.1 percent at L3, and 10.4 percent at thoracic vertebra 12 (T12), making these the most commonly injured vertebrae.

Over half (52 percent) of injuries to the thoracic spine were compression fractures, while transverse process fractures (48 percent) were the most common injuries to the lumbar spine. Injuries were most common (34 patients) in those aged 30-39 years and were least common (12 patients) in those under 18 years. A smaller peak in injuries occurred in those aged 70-79 years.

Previous studies of TL spine injury, which focused only on special populations and did not reflect the pattern of injuries seen in the ED, were of limited use to ED physicians.

More details are in "Epidemiology of thoracolumbar spine injury in blunt trauma," by James F. Holmes, M.D., Paul Q. Miller, B.ScH., Edward A. Panacek, M.D., and others, in the September 2001 Academic Emergency Medicine 8, pp. 866-872.

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