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Stable versus unstable
Generally:
- one column; Stable
- two columns; Stable / unstable
- three columns; Unstable
• T-spine fractures (T1-10) often stable due to support from thoracic cage and orientation of facets (? injury to thoracic cage)
Fracture prevalence
In adults:
90% of all thoracolumbar spine fractures occur between T11 and L4
60-70% occur at T12, L1 & L2
T11 / T12 should be included on all trauma lumbar spine films
20% are associated with other skeletal injuries:
- Compression fracture at the thoracolumbar junction + fractures of the os calcis
- Upper thoracic spine wedge fractures + sternum fractures
Spondylolysis
Pars interarticlularis defect
Unilateral / bilateral
Acute trauma / stress fracture / congenital
Usually L4 / 5-L5S1
Progresses to spondylolisthesis
Spondylolisthesis
Ventral slip of vertebra
Result of a pars interarticularis defect or #
Graded by degree of slip onlateral:
- Grade1 = <25% of body width
- Grade2 = 25-50%
- Grade 3 = 50-75%
- Grade 4 = 75% and over
Pseudo-spondylolisthesis
- No pars defect
- Degenerative origin
- Facet joint dislocation
Chance # (# Distraction Injury)
High energy distraction injury extending classically through the spinous process, pedicles, and vertebral body
May include a burst or compression element
Also called a "seat-belt" #
Acute forward flexion with distraction of the spine
Typically the posterior and middle columns are disrupted
High association with intra-abdominal trauma
Radiographic features:
- “Empty vertebral body” (posterior elements not superimposed) on AP
- Increased interspinous distance
- Horizontal #s of spinous process / lamina / pedicles running into the
vertebral endplates
- Increased interpedicular distance if burst element
- +/- compression # of vertebral body
- +/- localized bulge paraspinal line
Fracture Dislocations
High energy injury with many potential mechanisms
Typically disruption to all three columns
Associated with neurological deficit
CT / MRI required
Isolated transverse process fracture:
High energy injury
Often subtle
SOS
Overlying bowel gas
May be associated with intra-abdominal injuries
Spondylosis
Abnormal condition + spine
Vertebral column osteoarthritis
Reduced intervertebral disc space
Osteophytes formation (oblique or horizontal helps differentiate from
syndesmophytes)
Ankylosis spondylitis
Fusing inflammation + spine
Inflammatory arthritide
Free fragments
For any disc extrusion it is critical to diagnose the presence of a free fragment or sequestration
Disc material cephalad or caudal to the disc space is diagnosed as a free fragment on MRI (whether attached or not!)
Wedge / Compression #
75% of thoracic & lumbar vertebra #
• Anterior compression #
• Axial compression, lateral flexion or hyperflexion
• Middle column remains intact acting as a hinge
• Posterior column normal or distraction
• Pathological #?
Osteoporosis
- Metastatic deposits
Compression fractures
Radiographic features:
• AP
- Decrease in height of body
- Buckling of the lateral cortices
- +/- localized bulge paraspinal line
• Lateral
- Wedge shape to vertebra or depression of superior endplate
- Anterior body height reduces
- Posterior body height / cortex intact (concavity)
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