van Den Hauwe Luc, Sundgren Pia C., Flanders Adam E.
Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
Institution for Clinical Sciences/Radiology, Lund University, Lund, Sweden
The majority of the spinal injuries (60%) affect young healthy males between 15 and 35 years of age with cervical spine injuries to be most common. The main cause for spinal injuries is blunt trauma most commonly due to motor vehicle accidents (48%) followed by falls (21%), and sport injuries (14.6%). Assault and penetrating trauma account for approximately 10–20% of the cases. Injuries to the spinal column and the spinal cord are a major cause of disability, affecting predominately young healthy individuals with important socioeconomic consequences and the costs of lifetime care and rehabilitation exceed one million US dollars per patient excluding financial losses related to wages and productivity. Over the past several decades, the mean age of the spinal cord injured patient has increased which is attributed to a substantially greater proportion of injuries related to falls in the elderly. Cervical spine injuries, of which approximately one-third occur in the craniocervical junction (CCJ) (Riascos et al., Radiographics 35:2121–2134, 2015), account for the majority of the spinal injuries followed by thoracolumbar fractures. Almost half of the spinal injuries result in neurological deficits, often severe and sometimes fatal (Hill and Dean, J Trauma 34:549–554, 1993). Survival is inversely related to the patient’s age, and neurologic level of injury, with lower overall survival for high quadriplegic patients compared to paraplegic injuries. Mortality rate of spinal cord injury during the initial hospitalization is reported to be almost 10% (Pope and Tarlov, Disability in America: toward a national agenda for prevention, National Academy Press, Washington, 1991). Injury to the spinal cord occurs in 10–14% of spinal fractures and dislocations with injuries of the cervical spine being by far the most common cause of neurological deficits (40% of cervical injuries) (Riggins and Kraus, J Trauma 17:126–130, 1997; Castellano and Bocconi, Bull Hosp J Dis Orthop Inst 31:188–198, 1970). The majority of injuries to the spinal cord (85%) occur at the time of trauma, whereas in a minority of cases (5–10%) the spinal cord injury occurs in the immediate post-injury period (Rogers, J Bone Joint Surg 39:341–351, 1957). The imaging methods for evaluating patients with acute spinal trauma have dramatically changed in the last decade especially with the development of thin section multi-detector computed tomography (MDCT) and isotropic datasets that provide high-resolution sagittal and coronal reformats. MDCT allows for a comprehensive assessment of spinal column injury that has largely supplanted radiography except in the pediatric population. Magnetic resonance imaging (MRI) has become the procedure of choice for evaluation of the spinal cord and surrounding soft tissues when a reliable neurologic examination cannot be performed.
大多数脊柱损伤（60%）发生在15至35岁的年轻健康男性身上，其中颈椎损伤最为常见。脊柱损伤的主要原因是钝性创伤，最常见的是机动车事故（48%），其次是跌倒（21%）和运动损伤（14.6%）。袭击和穿透性创伤约占病例的10 - 20%。脊柱和脊髓损伤是致残的主要原因，主要影响年轻健康个体，具有重要的社会经济后果，每位患者终身护理和康复费用超过100万美元，不包括与工资和生产力相关的经济损失。在过去几十年中，脊髓损伤患者的平均年龄有所增加，这归因于老年人中与跌倒相关的损伤比例大幅上升。颈椎损伤约三分之一发生在颅颈交界区（CCJ）（里亚斯科斯等人，《放射学》35:2121 - 2134，2015年），占脊柱损伤的大多数，其次是胸腰椎骨折。几乎一半的脊柱损伤会导致神经功能缺损，通常很严重，有时甚至致命（希尔和迪恩，《创伤杂志》34:549 - 554，1993年）。生存率与患者年龄和损伤的神经平面成反比，高位四肢瘫患者的总体生存率低于截瘫患者。据报道，脊髓损伤患者在初次住院期间的死亡率几乎为10%（波普和塔尔洛夫，《美国的残疾：迈向全国预防议程》，美国国家科学院出版社，华盛顿，1991年）。脊髓损伤发生在10% - 14%的脊柱骨折和脱位中，颈椎损伤是迄今为止导致神经功能缺损最常见的原因（40%的颈椎损伤）（里金斯和克劳斯，《创伤杂志》17:第126 - 130页，1997年；卡斯特利亚诺和博科尼，《骨科医院杂志》31:188 - 198，1970年）。大多数脊髓损伤（85%）发生在创伤时，而在少数情况下（5% - 10%），脊髓损伤发生在损伤后即刻（罗杰斯，《骨与关节外科杂志》39:341 - 351，1957年）。在过去十年中，用于评估急性脊柱创伤患者的成像方法发生了巨大变化，特别是随着薄层多探测器计算机断层扫描（MDCT）和提供高分辨率矢状面和冠状面重建的各向同性数据集的发展。MDCT允许对脊柱损伤进行全面评估，除了儿科人群外，它在很大程度上取代了X线摄影。当无法进行可靠的神经学检查时，磁共振成像（MRI）已成为评估脊髓和周围软组织的首选检查方法。
