Abdominal CT for trauma: an adequate screen for lower thoracic and lumbosacral fractures?

Purpose: To assess the utility of routine trauma abdomen and pelvic CT for the detection of lumbosacral spine fractures. Materials and methods: The radiology records of the University of Arizona Medical Center over a 12-month period were reviewed. Fifty-eight patients with suspected blunt abdominal trauma were studied who had both abdominal CT and radiographs of lumbosacral spine. Twenty-two had one or more fractures of the lumbosacral spine. Thirty-six patients who underwent both imaging studies and had no fracture identified by either modality were selected as controls. The images were reviewed independently by three radiologists who were blinded to the CT and plain radiograph findings. Following the blinded review, all discrepancies were reviewed by the interpreting radiologists who then arrived at a consensus interpretation. A fracture was determined to be present if, by consensus of the reviewers, it was seen on either the CT scan or plain radiograph. Results: Thirty-two fractures were identified; 28 (88 %) were identified on CT, 17(53 %) were seen on plain films. Overall routine abdominal CT is significantly more sensitive in the detection of fracture than plain radiographs. No unstable injuries were missed on plain film while one fracture dislocation was missed on CT. Conclusion: Bone images obtained from routine trauma abdomen and pelvic CT are significantly more sensitive than radiographs in the detection of fractures of the lumbosacral spine. However, CT alone may miss significant injuries.