A - PREHOSPITAL AND EMERGENCY

Assess the individual with suspected thoracic or lumbosacral spine injury using these factors:

1. age 65 years or older and reported pain in the thoracic or lumbosacral spine
2. dangerous mechanism of injury (fall from a height of greater than 3 metres, axial load to the head or base of the spine – for example, falls landing on feet or buttocks, high-speed motor vehicle collision, rollover motor accident, lap belt restraint only, ejection from a motor vehicle, an accident involving motorized recreational vehicles, bicycle collision, horse riding accidents)
3. pre-existing spinal pathology (i.e., ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis), or known or at risk of osteoporosis – for example, steroid use
4. suspected spinal fracture in another region of the spine
5. abnormal neurological symptoms (paraesthesia or weakness or numbness)
6. on examination:
   1. abnormal neurological signs (motor or sensory deficit)
   2. new deformity or bony midline tenderness (on palpation)
   3. bony midline tenderness (on percussion)
   4. midline or spinal pain (on coughing)
7. on mobilization (sit, stand, step, assess walking): pain or abnormal neurological symptoms (stop if this occurs)