Neglected spinal injuries.

Abstract

Neglected spinal injuries secondary to overlooked diagnosis may result in serious medical and medicolegal problems. These are not uncommon but are reported infrequently in the medical literature. I studied the incidence, causes, and consequences of neglected spinal injuries and recommendations for prevention and treatment by reviewing the literature found in a Medline search. Overlooked spinal injuries are most frequently seen in unconscious or intoxicated patients and in polytrauma patients with distracting remote injuries. These are 4.5 times more frequent in the cervical spine compared with the thoracolumbar spine. The most common cause is failure to obtain radiographs. Other causes include a failure to recognize the injury or the fact that the initial studies may fail to show the injuries. Use of computed tomography and magnetic resonance imaging scans as screening tests may be good ways to diagnose these injuries, but their use is limited by cost and availability. The most serious consequence of overlooked spinal injuries is progressive neural deficit. More frequently they result in progressive deformity and persistent pain requiring surgical intervention that most likely could have been avoidable, often with an unsatisfactory outcome. Untreated or inadequately treated spinal injuries with late presentation are more often seen in the developing world. Unfortunately, reports on these cases are published rarely. Their brief report in the current study is based on search of nonindexed medical journals using in Internet search engine and personal communications.