![]() MRI is utilized when there are signs or concerns for spinal cord involvement and produces excellent visualization of the spinal canal, spinal cord, and the ligamentous elements of the vertebral bodies. Routine use of CT as an initial imaging test should be discouraged. For example, spine reconstruction imaging from an abdomen and pelvis CT will include the lower thoracic spine, but not the upper thoracic spine. In such cases, the reconstructed spine CT imaging will include only those areas included in the body scan. Reconstruction of the included spine is useful for fracture detection and is performed with no additional radiation exposure. CT is also used to evaluate the spine when a patient is undergoing body CT as part of a trauma evaluation. Which spinal segments should be initially imaged can be based on history and clinical examination findings.ĬT is often utilized as an adjunct study to better visualize fractures identified on plain imaging, especially complex fractures, as CT gives excellent visualization of bony elements of the spine and depicts retropulsion of fracture fragments. A two-view study (anteroposterior and lateral) is sufficient, and a complete view of the segment of interest is essential. Plain film radiography is the initial imaging modality of choice. She is able to ambulate but complains of mid-thoracic back pain. There are no obvious external signs of trauma (i.e., no hematoma, bruising, or abrasion) and there are no step-offs, crepitus, or deformities. She complains of diffuse tenderness around her mid-thoracic spine but cannot pinpoint a precise location of pain. ![]() There is no chest or abdominal tenderness. Her physical examination reveals no fever, a heart rate of 100 beats per minute, a blood pressure of 105/54 mm Hg, and room air oxygen saturations of 99%. She did not strike the handlebars and has no chest or abdominal pain. There is no reported loss of consciousness and she was wearing a helmet. She states that she was riding her bike and attempted to “pop a wheelie.” In doing so, she fell backward, separating herself from the bike, landing initially on her buttocks, but then onto her back. A 9-year-old female seeks care after falling from her bicycle.
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