Neuroradiologist Consultant, Department of Radiology, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
Department of Radiology, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
Eur J Radiol. 2019 Aug;117:75-88. doi: 10.1016/j.ejrad.2019.05.007. Epub 2019 May 7.
Spinal traumas represent a significant proportion of muscle-skeletal injuries worldwide. Spinal injuries involve a complex structure with components having different traumatic susceptibility and variable healing capabilities. The interaction of numerous variables at time of trauma creates a great variety of lesions which makes challenging the creation and comparison of homogeneous groups, with difficulties in classifying spinal lesions, in assessing their instability, and in defining the indication and outcome of different treatment strategies. The evolution of concepts on instability has accompanied that of traumas classification schemes and treatment strategies. The assessment of instability in a spinal injury is actually crucial in front of newer surgical techniques and hardwares. Despite a long history of attempts to classify spinal traumas, it remains some degree of controversy in describing imaging data and a wide variety of treatment strategies. Acute cervical spine injuries affect from 1.9% to 4.6% of subjects reporting a blunt trauma, and up to 5.9% of multiple-injured patients. Most of spinal cord injuries are a consequence of unstable fractures of the cervical spine. An accurate and early diagnosis is mandatory to prevent neurological damage in unstable fractures. Classic and newer classifications are primarily based on features identifiable by using conventional imaging and CT scan, which are the most available modalities at most trauma centers. Even though multidetector-CT remains superior in assessing with high accuracy bone injuries, MRI is the most sensitive modality for detecting soft tissues injuries and spinal cord damage.
脊柱创伤占全球肌肉骨骼损伤的很大一部分。脊柱损伤涉及一个复杂的结构，其组成部分具有不同的创伤易感性和不同的愈合能力。在创伤发生时，许多变量的相互作用产生了各种各样的损伤，这使得创建和比较同质组变得具有挑战性，对脊柱损伤进行分类、评估其不稳定性以及确定不同治疗策略的适应证和结果都存在困难。不稳定性概念的演变伴随着创伤分类方案和治疗策略的演变。在新的手术技术和硬件面前，对脊柱损伤不稳定性的评估实际上至关重要。尽管人们长期以来一直试图对脊柱创伤进行分类，但在描述影像学数据和各种治疗策略方面仍存在一定程度的争议。急性颈椎损伤影响报告钝性创伤的患者的 1.9%至 4.6%，以及多达 5.9%的多发伤患者。大多数脊髓损伤是颈椎不稳定骨折的后果。准确和早期的诊断对于预防不稳定骨折中的神经损伤是强制性的。经典和较新的分类主要基于使用常规成像和 CT 扫描可识别的特征，这些特征是大多数创伤中心最常用的方式。尽管多排 CT 在评估骨损伤方面仍然具有较高的准确性，但 MRI 是检测软组织损伤和脊髓损伤的最敏感方式。
