Noncontiguous injuries of the spine.

A total of 372 consecutive spinal injury patients were evaluated at the Regional Spinal Cord Injury Center of Delaware Valley. Of these, 39 patients (10.5%) were found to have noncontiguous spinal column injuries. Fewer than half of the patients in our series could be classified into previous classification systems (Calenoff, Gupta) of noncontiguous spinal fractures. Fifteen fractures in 12 patients were missed on presentation on admission and 25% of these patients had a progressive neurologic deficit as a result of improper initial immobilization. The location of missed fractures were found to be primarily at the extremes or junctures of the spine (i.e., cervicothoracic, thoracolumbar). Complete spinal roentgenographic evaluation is recommended in the workup of suspected spinal column injury patients, and additional imaging modalities (i.e., tomograms, computed tomography scans, and magnetic resonance imaging) may be necessary in those areas of the spine difficult to visualize.