title: Isolated vertebral fractures give elevated serum protein S-100B levels.
abstract: BACKGROUND
  Serum protein S-100B determinations have been widely proposed in the past as markers of traumatic brain injury and used as a predictor of injury severity and outcome. The purpose of this prospective observational case series was therefore to determine S-100B serum levels in patients with isolated injuries to the back.
  
  
  METHODS
  Between 1 February and 1 May 2008, serum samples for S-100B analysis were obtained within 1 hour of injury from 285 trauma patients. All patients with a head injury, polytrauma, and intoxicated patients were excluded to select isolated injuries to the spine. 19 patients with isolated injury of the back were included. Serum samples for S-100B analysis and CT spine were obtained within 1 hours of injury.
  
  
  RESULTS
  CT scans showed vertebral fractures in 12 of the 19 patients (63%). All patients with fractures had elevated S-100B levels. Amongst the remaining 7 patients without a fracture, only one patient with a severe spinal contusion had an S-100B concentration above the reference limit. The mean S-100B value of the group with fractures was more than 4 times higher than in the group without fractures (0.385 vs 0.087 microg/L, p = 0.0097).
  
  
  CONCLUSIONS
  Our data, although limited due to a very small sample size, suggest that S-100B serum levels might be useful for the diagnosis of acute vertebral body and spinal cord injury with a high negative predictive power. According to the literature, the highest levels of serum S-100B are found when large bones are fractured. If a large prospective study confirms our findings, determining the S-100B level may contribute to more selective use of CT and MRI in spinal trauma.
authors.affiliation: Department of Emergency Medicine, Bern University Hospital, Bern, Switzerland. lorin.benneker@insel.ch
authors.forename: Lorin M
authors.initials: LM
authors.lastname: Benneker
authors.forename: Christoph
authors.initials: C
authors.lastname: Leitner
authors.forename: Luca
authors.initials: L
authors.lastname: Martinolli
authors.forename: Kretschmer
authors.initials: K
authors.lastname: Robert
authors.forename: Heinz
authors.initials: H
authors.lastname: Zimmermann
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos