Trauma: Thoracolumbar Spine

Trauma: Thoracolumbar SpineCreated OnMay 4, 2020Last Updated OnMay 4, 2020byadmin You are here: Main Radiology Trauma: Thoracolumbar Spine < All Topics Table of Contents Key points on reading Thoracolumbar Spine X-Ray Use a systematic approach Correlate radiological findings with the clinical features If ‘instability’ is suspected, then further imaging with CT should be considered If you see one fracture – check for another Thoracic Spine X-Ray – Standard views AP and Lateral – Assess both views systematically Images of the thoracic and lumbar spine are often large and the bones should be scrutinized in detail. Note: The upper T-spine may not be visible on the lateral view – if injury is suspected here then a swimmer’s view may be helpful Thoracic Spine (T-Spine) systematic approach – Lateral and AP Coverage – The whole spine is visible on both views Alignment – Follow the corners of the vertebral bodies from one level to the next Bones – The vertebral bodies should gradually increase in size from top to bottom Spacing – Disc spaces gradually increase from superior to inferior – Note: Due to magnification and spine curvature the vertebral bodies and discs at the edges of the image can appear larger than those in the centre of the image Soft tissues – Check the paravertebral line (see AP image below) Edge of image – Check the other structures visible T-Spine normal anatomy – Lateral Alignment – Vertebral body alignment is assessed by carefully matching the anterior and posterior corners of the vertebral bodies with the adjacent vertebra Bones – Gradual increase in vertebral body height from superior to inferior Spacing – Disc spaces gradually increase in height from superior to inferior VB = Vertebral body P = Pedicle SP = Spinous process (ribs overlying) F = Foramen – spinal nerve root exit T-spine normal anatomy – AP Alignment – The vertebral bodies and spinous processes (SP) are aligned Bones – The vertebral bodies and pedicles are intact Other visible bony structures include the transverse processes (TP), ribs, and the costovertebral and costotransverse joints Spacing – Each disc space is of equal height when comparing left with right. The pedicles gradually become wider apart from superior to inferior Soft tissue – Note the normal paravertebral soft tissue which forms a straight line on the left – distinct from the aorta Lumbar Spine (L-Spine) X-rays – AP and Lateral L-spine systematic approach – Lateral Coverage – The whole L-spine should be visible on both views Alignment – Follow the corners of the vertebral bodies from one level to the next (dotted lines) Bones – Follow the cortical outline of each bone Spacing – Disc spaces gradually increase in height from superior to inferior Note: The L5/S1 space is normally slightly narrower than L4/L5 L-spine normal anatomy – Lateral (detail) Check the cortical outline of each vertebra The facet joints comprise the inferior and superior articular processes of each adjacent level The pars interarticularis literally means ‘part between the joints’ P = Pedicle SP = Spinous process L-spine systematic approach – Normal AP Alignment – The vertebral bodies and spinous processes are aligned Bones – The vertebral bodies and pedicles are intact Spacing – Gradually increasing disc height from superior to inferior. The pedicles gradually become wider apart from superior to inferior Note: The lower discs are angled away from the viewer and so are less easily assessed on this view L-spine normal anatomy – AP (detail) Check carefully for pedicle integrity and transverse process fractures Three column model A simple model commonly used for assessment of spinal stability. If any 2 columns are injured, then the injury is ‘unstable’. This theory is an over simplification if applied to plain X-rays alone. It is important to be aware that some injuries are not visible on X-ray and that 2 and 3 column injuries may be underestimated as 1 or 2 column injuries respectively. If spinal instability is suspected on the basis of clinical or radiological grounds, then further imaging with CT should be considered. Three column model – Fracture simulation Injuries 1 and 2 affect one column only and are considered ‘stable’ 1 – Spinous process injury 2 – Anterior compression injury Injuries 3 and 4 affect two or more columns and are considered ‘unstable’ 3 – ‘Burst’ fracture 4 – Flexion-distraction fracture – ‘Chance’ type injury Thoracolumbar spine – Abnormal Injury classification Spinal injuries which are seen to disrupt structures of 2 or more columns are considered ‘unstable’. If the middle column is seen to be injured, it is usually taken that another column must be injured even if no anterior or posterior column fracture is visible. RULE: If you...

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