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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020; 39(04): 294-299
DOI: 10.1055/s-0037-1615781
Review Article | Artigo de Revisão

Spinal Cord Injuries – When Is the Initial Tomography Insufficient?

Traumatismos raquimedulares – Quando a tomografia inicial é insuficiente?
Pedro Augusto Sousa Rodrigues 
1   Departament of Neurology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
,
Enrico Ghizoni
1   Departament of Neurology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
,
Helder Tedeschi
1   Departament of Neurology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
,
Andrei Fernandes Joaquim
1   Departament of Neurology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
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Abstract

Introduction Spinal cord injury (SCI) is common in polytrauma patients. The standard exam for the initial evaluation is computed tomography (CT), due to its higher sensitivity and specificity when compared with plain radiographs. However, CT is insufficient for the management of some cases, especially to evaluate ligamentous and spinal cord injuries. The objective of the present study is to describe clinical scenarios in which the CT scan was insufficient to guide the treatment of SCIs.

Methods We present the cases of four polytrauma patients with normal CT scans at admission and with unstable or surgically-treated lesions.

Discussion The cases reported evidence the need for ongoing neurological surveillance with serial physical examination and magnetic resonance imaging (MRI) in cases of neurological injury not explained by CT or occult instability.

Conclusion Computed tomography is not always sufficient to determine the management of SCIs. A comprehensive evaluation of the clinical data, CT findings and, occasionally, MRI findings is crucial in order to choose the best conduct.

Resumo

Introdução O trauma raquimedular (TRM) é frequente no paciente politraumatizado. O exame padrão para avaliação inicial é a tomografia computadorizada (TC), dada a alta sensibilidade e especificidade quando comparada às radiografias simples da coluna. Entretanto, a TC é insuficiente em algumas situações, principalmente no diagnóstico de lesões ligamentares e medulares. O objetivo deste trabalho é mostrar situações em que a TC não foi suficiente para o diagnóstico das lesões medulares e o manejo dos pacientes com TRM.

Métodos Apresentamos quatro pacientes, vítimas de politraumatismo, com TC normal na admissão, e com lesões da coluna instáveis ou que necessitaram de tratamento cirúrgico.

Discussão Os casos em questão retratam a necessidade de vigilância neurológica contínua com exame físico seriado e realização de ressonância magnética (RM) em casos de lesão neurológica não explicada pela TC ou suspeita de instabilidade oculta.

Conclusão A TC nem sempre é suficiente para o manejo do TRM. A avaliação global dos dados clínicos, achados tomográficos e, eventualmente, da RM, é fundamental para escolher a melhor conduta.

Keywords

spinal cord injury - computed tomography - polytrauma - diagnosis

Palavras-chave

traumatismo raquimedular - tomografia computadorizada - politraumatismo - diagnóstico


Publication History

Received: 01 November 2017

Accepted: 22 November 2017

Article published online:
21 December 2017

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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