After a primary survey, the stable patient who fell from a height and has bilateral calcaneal fractures should receive imaging of which spinal regions?

• A. Spine radiographs including cervical, thoracic, lumbar, and sacral vertebra
• B. Only cervical spine X-ray
• C. MRI of spine
• D. No imaging initially

Answer: (A)

A high-energy fall with bilateral calcaneal fractures signals a significant axial load through the spine, so injuries can be present at multiple levels. In the secondary survey of a stable trauma patient, the safest approach is to image the entire spine—cervical, thoracic, lumbar, and sacral—to avoid missing a fracture that could alter management or transfer decisions. Cervical imaging alone could miss thoracic, lumbar, or sacral injuries, and while MRI can reveal soft-tissue or cord concerns, it’s not the first-line screen for acute bony injuries. No imaging would risk overlooking a potentially unstable spinal fracture.