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THORACIC LUMBAR SACRAL (TLS) SPINE CLEARANCE
|These pages are excerpted from the Trauma
Resident Handbook, Rhode Island Hospital Department of Surgery,
Division of Trauma - updated 2001. The policies herein are intended
to serve as guidelines only. Individual circumstances need to
be considered as there may be times when it is appropriate or
desirable to deviate from these guidelines. These educational
guidelines will be reviewed and updated routinely.
Thoracic spine fractures occur at about the same rate as cervical
spine fractures - 2-5% of the blunt trauma population. While
the majority of these patients presents with pain and tenderness,
a significant minority (which can approach 20%) do not have associated
pain and tenderness at presentation. This may be due to a decrease
in sensorium or distracting major injuries, which preclude a
reliable physical examination. While the vast majority of patients
with vertebral fractures who develop neurologic deficits will
have them at the time of presentation in the trauma room, a few
will develop them in a delayed manner. The purpose of these guidelines
is to increase our detection of subtle TLS fractures and possibly
prevent the development of late-onset neurologic sequelae.
All patients with blunt injury should be suspected
of having a cervical or thoracic spine injury. The cervical spine
should be cleared according to our established protocol and the
thoracic spine should be cleared as outlined. All patients should
be kept on spine precautions, which includes in-line immobilization
of the cervical and upper thoracic spine during any procedures
and logrolling. Only after the patient has had an evaluation
as outlined and is without a TLS fracture should spine precautions
- Cooper C, Dunham CM, Rodriquez A: Falls and
major injuries are risk factors for thoracolumbar fractures:
Cognitive impairment and multiple injuries impede the detection
of back pain and tenderness. J Trauma 38:692-696, 1995.
- Meldon SW, Moettus LN: Thoracolumbar spine
fractures: Clinical presentation and the effect of altered sensorium
and major injury. J Trauma 39:1110-1114, 1995.
- Reid DC, Henderson R, Saboe L, et al.: Etiology
and clinical course of missed spine fractures. J Trauma 27:980-6,
- Samuels LE, Kerstein MD: "Routine"
radiologic evaluation of the thoracolumbar spine in blunt trauma
patients: A reappraisal. J Trauma 34:85-89, 1993.
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