Thoracolumbar spine fractures: is there a problem?

Every physician who treats injured patients has a responsibility to detect and appropriately manage thoracolumbar spinal column injuries. Fractures of the thoracolumbar spine are relatively common, so clinicians must give them every consideration both to protect from secondary spinal cord injury and to appreciate the extent of the patient's injuries. Other extraspinal as well as noncontiguous injuries to the spinal column are frequently present. Unfortunately, thoracolumbar spine fractures are often missed or diagnosed late in clinical series. In an era of cost-containment, not all responsive patients require full thoracolumbar spine radiographs. In awake, alert, nonintoxicated patients with simple injury mechanisms, these fractures can be ruled out through physical examination, if the patient has no physical findings and does not have other serious injuries. However, concern has recently been raised that some patients may have "asymptomatic" fractures that may be missed without radiography. The evidence reveals that fractures are not truly asymptomatic but may be masked by other distracting injuries, making them fractures occult rather than asymptomatic. Clinicians and subsequently their patients will always be at risk if this important distinction is forgotten.