Motion artifact on computed tomography scan suggesting an unstable 3-column spine injury: case report of a "near miss" root cause of unneeded surgery

BACKGROUND: Polytrauma patients often present with altered mental status, thus making clinical examination challenging. Due to its reliability for detecting traumatic injuries to the spine, computed tomography (CT) is generally the imaging study of choice when the mechanism of injury and/or preliminary exam suggests spinal injury. However, motion artifact may lead to false diagnoses. CASE REPORT: A 19-year-old intoxicated female involved in a high-speed motor vehicle crash suffered multiple spine, head, chest, and abdominal injuries. CT scan also suggested an unstable three column ligamentous injury at L2-3. Preparations were made for surgery the following morning, by which time her mental status had improved. She was re-examined in the operating room prior to induction by anesthesia and no focal lumbar pain or tenderness was detected. Imaging was further reviewed and motion artifact at the L2-3 level was noted. The surgery was cancelled. CONCLUSION: Motion artifact mimicked an unstable three column ligamentous injury at the L2-3 level. Findings on CT scan should always be correlated to physical exam in order to avoid wrongful surgical intervention.