![]() The early identification of spinal injuries is critical in the initial management of the trauma patient to avoid adverse events due to incorrect immobilization and mismanagement. Spinal injuries are a common finding in polytraumatized patients with an incidence of 18–40%. However, if spinal injuries are suspected, performing a full-body CT scan is necessary for correct diagnosis. In polytraumatized patients, AP-LS, implemented in the Advanced Trauma Life Support-algorithm, is a helpful tool to diagnose life-threatening injuries. This study demonstrated high specificity with low sensitivity of AP-LS in detecting spinal injuries compared to CT scan. Potentially unstable spinal injuries were more likely to be detected than stable injuries (sensitivity 18 and 6%, respectively). The sensitivity was highest for thoracic spinal injuries (14%). AP-LS had a low sensitivity of 9% (31 of 332, range 0–24%) and high specificity of 99% (range 98–100%). On CT scan, 207 patients presented with a spinal injury (65%, total of 332 injuries). The study group included 320 patients (48.5 years ☑9.5, 89 women). The sensitivity of AP-LS was further analyzed by the severity of spinal injuries. Interrater reliability between the three observers was calculated using Fleiss’ Kappa. The diagnostic accuracy was evaluated by using the area under the ROC (receiver operating characteristic curve) for sensitivity and specificity. The sensitivity and specificity of correct diagnosis with AP-LS compared to CT scan were calculated. Therefore, within 3 years, AP-LS of polytraumatized patients (ISS ≥ 16) were retrospectively analyzed by three independent observers. We aimed to analyze the diagnostic accuracy and the interrater reliability of AP-LS to detect spinal injuries in polytraumatized patients. The Lodox-Statscan (LS) has evolved into a promising time-saving diagnostic tool to diagnose life-threatening injuries with an anterior-posterior (AP)-full-body digital X-ray. Rapid identification of spinal injuries requiring immobilization or operative treatment is essential. horizontal beam imaging can produce unwanted image artefact.Spinal injuries are present in 16–31% of polytraumatized patients.exaggerated thoracic kyphosis can mean the field of view is wide and can include the majority of the anterior thorax be aware of this when collimating and choosing the coronal centering point.the three-column concept of thoracolumbar spinal fractures is of particular importance when assessing this image for pathology.If clinical concern for injury in this area is strong, the cervical spine: swimmer's lateral view can be included, or referral to CT can be made visualization of the upper thoracic spine is often difficult given the patient thickness at this region.adequate image penetration and image contrast is evident by clear visualization of thoracic vertebral bodies, with both trabecular and cortical bone demonstrated.intervertebral joints and neural foramen are open, with the superimposition of the posterior spinous processes and posterior rib articulation indicating a true lateral has been achieved.The entire thoracic spine should be visible from T1 to T12: ![]() yes (ensure the correct grid is selected if using focussed grids).anterior and posterior to include the anterior margin of all thoracic vertebrae and posterior to include the posterior column elements.inferiorly to include the T12/L1 junction.superiorly to include the C7/T1 junction.the central ray is perpendicular to the image receptor.the level of the 7th thoracic vertebra, which correlates to the inferior border of the scapula, centered directly over the thoracic spine (most commonly equates to the posterior third of the thorax).suspended expiration (or breathing technique if possible).in all variations of positioning, the humeri are extended 90º to the thorax, with the elbows flexed so that the forearms are parallel to the thorax.the lateral projection requires the upper limbs to be removed from the path of the direct x-ray beam, minimizing the superimposition of the proximal humeri over the thoracic vertebrae.all imaging of patients with a suspected spinal injury must occur in the supine position without moving the patient.ideally, spinal imaging should be taken erect in the setting of non-trauma to give a functional overview of the thoracic spine.the patient is erect, supine or lateral decubitus depending on clinical history.It can help to visualize any compression fractures, subluxation or kyphosis, and is used in conjunction with the AP view to complete a thoracic spine series. This projection is utilized in many imaging contexts including trauma, postoperatively, and for chronic conditions.
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