This document discusses key things to identify and types of cervical, thoracic, and lumbar spine injuries seen on radiographs. It identifies things like equal disc spaces, vertebral body height and alignment on cervical spine views. It also describes fracture patterns for the cervical spine like odontoid fractures and compression fractures. For the thoracic and lumbar spine, it discusses compression fractures, burst fractures, and flexion-distraction injuries, noting stability, neurological risks, and mechanisms of injury.

11. Alignment

12. Key Things to Identify
• Predental space –
should be 3mm or less

13. • Disc spaces should be
the equal and
symmetric

14. • Prevertebral soft tissue

15. AP View• The height of the cervical
vertebral bodies should be
approximately equal
• The height of each joint
space should be roughly
equal at all levels.
• Spinous process should be
in midline and in good
alignment.

16. Odontoid View
• The distance from the
dens to the lateral
masses of C1 should be
equal bilaterally.

17. • Secondary to hyperextension
• Best seen on lateral view
• Signs:
– Prevertebral soft tissue
swelling
– Avulsion of anterior inferior
corner of C2
– Anterior dislocation of the
C2 vertebral body.

19. • Fracture of the odontoid (dens) of C2
• 3 categories, I-III
• Best seen on the lateral view
• Signs:
I – Fx through superior portion of dens
II – Fx through the base of the dens
III – Fx that extends into the body of C2

20. Type II

21. Type III

22. • Anterior compression fracture of the vertebral body
which results from a severe flexion injury.
• Signs:
o Prevertebral swelling
o Teardrop fragment from anterior vertebral body
avulsion fracture.
o Posterior vertebral body subluxation into the
spinal canal.
Spinal cord compression from vertebral body
displacement.
Fracture of the spinous process.

24. • Fracture of C3-C7 that results from
axial compression.
• CT is required for all patients to
evaluate extent of injury.

26. • Fracture of a spinous process C6-T1
• Signs:
– Spinous process fracture on lateral view.
– Ghost sign on AP view (i.e. double spinous
process of C6 or C7 resulting from displaced
fractured spinous process).

28. • Compression fracture resulting from flexion.
• Signs:
– Buckled anterior cortex.
– Loss of height of anterior vertebral body.
– Anterosuperior fracture of vertebral body.

31. Thoracic: AP, lateral, swimmer’s views
Lumbar: AP, lateral
Thoracic and Lumbar Spine
Trauma

32. Thoracic and Lumbar Spine
Trauma

33. Thoracic and Lumbar Spine
Trauma

34. Thoracic and Lumbar Spine
Trauma

35. Thoracic and Lumbar Spine
Trauma

38. • Stable: Isolated to body, less than 50% loss of
height, 1 or 2 levels only
• Unstable: Posterior arch involved, or more than
50% loss of height, or more than 2 levels
• Neurologic injury: Uncommon

40. • Compression fracture of body and transverse
posterior arch fracture
• Most common at T10-L2
• Unstable
• Neurologic injury in 15%, abdominal injury in 50%
(tear of mesentery, bowel injury): always CT spine
AND abdomen
• Mechanism: FLEXION over a lap seat belt

41. • Marked flexion force
• Frequently at T10-L2
• Very unstable
• Severe cord/cauda equina injury is common

44. • Compression fracture of body with superior and inferior
end plate fractures, posterior arch fracture with laterally
displaced pedicles
• Very unstable
• Over 2/3 have cord injury from retropulsed fragments.
• Axial load/flexion combined mechanism