Multiple level spinal injuries: importance of early recognition.

Patients with severe trauma may simultaneously sustain more than one level of spinal injury. Often, the second or third levels of injury are not recognized early enough to prevent clinically significant extension of the neurologic deficit, pain pattern, spinal instability, and/or deformity. A review of 710 spinal injury patients admitted to the Midwest Regional Spinal Cord Injury Care System yielded 4.5% multiple noncontiguous vertebral injuries. Thirty cases were studied in respect to location and type of primary and secondary injury. Of the secondary lesions, 40% occurred above and 60% below the primary lesion. In half of the patients, there was a mean of 52.6 days delay in diagnosis of the secondary lesion. Three major patterns of injury emerged from this analysis. Knowledge of these patterns and careful total spine radiography in patients with severe trauma may be a significant aid in early recognition of multiple level injuries and possible prevention of their complication.