Radiological Investigations of spinal Trauma.pptx

1. Abdelaziz Ah. Ibrahim
Orthopaedic Specialist
.
H.S.H

2. Background:
 Fractures of the vertebral column are important not
only because of the structures involved but also
because of the complications that may arise affecting
the spinal cord.
 Constituting approximately 3% to 6% of all skeletal
injuries, fractures of the vertebral column are most
commonly encountered in people between the ages
of 20 and 50 years, with the majority of cases (80%)
being seen in males.
 Most spinal fractures occur at the thoracic and
lumbar level.

3.  Injury to the cervical area has a greater potential risk for
spinal cord damage.
 Automobile accidents, sports-related activities (e.g.,
diving, skiing), and falls from heights are usually the
circumstances in which spinal injuries are sustained.
 The spine is composed of 33 vertebrae: 7 cervical, 12
thoracic, 5 lumbar, a sacrum of 5 fused segments, and a
coccyx of 4 fused segments.
 With the exception of the first and second cervical
vertebrae (C1 and C2), the vertebral bodies are separated
from each other by intervertebral disks.
 Patients complaining of back pain after motor vehicle
accidents or falls from significant heights should be
considered to have spinal injuries until proven otherwise.

4. Imaging modalities
Conventional Radiography (X-Ray).
Computed Tomography (CT).
MRI.

8. Absolute
contraindication
of dynamic views in spinal
trauma

18. Cervical spine should remain immobilized
until the patient has been cleared either no
injury or the extent of injury has been
determined.

20. Lateral view. (A) For the erect lateral view of the cervical spine, the patient is
standing or seated, with the head straight in the neutral position. The central
be am is directed horizontally to the center of the C4 vertebra (at the level of
the chin).
(B) For the cross-tab le lateral view, the patient is supine on the radiographic
table. The radiographic cassette (a grid cassette to obtain a clearer image) is
adjusted to the side of the neck, and the central be am is directed
horizontally to a point (red dot) approximately 2.5 to 3 cm caudal to the
mastoid tip.

22. (C) The radiograph in this projection clearly shows the vertebral bodies,
apophyseal joints, spinous processes, and intervertebral disk spaces. It is
mandatory to demonstrate the C7 vertebra. (Continue d)
C

57. The most severe fracture of the cervical
spine, often causing anterior cervical
cord syndrome and quadriplegia.

66. Burst Fracture
•C3-C7.
• Theory - compressed disc bulges into
inferior endplate causing VB to
explode from the inside.
• Usually with injury to spinal canal.
• ALL, disc, posterior column intact.
• STABLE.

75. Lumbar spine trauma.
Drawing of the primary
force involved in
compression burst injury of
the lumbar spine.
The vertical force is directed
into the central portion of
the lumbar endplate
(arrow).
The force results in both
downward and axial
displacement of fragments
of the vertebral body
endplate

76. Lumbar spine trauma. Drawing of the mechanism of injury of the lumbar spine
burst injury is compared with an axial CT image.
The centrally applied vertical force results in radial expansion of the vertebral body
endplate. The posterior margin of the endplate may be displaced into the spinal
canal (arrow)

82. Burst fracture.

83. Burst
fractur
e.

84. Burst
fracture

85. Lumbar spine trauma. Axial T1-weighted MRI in a patient with lumbar spine
compression burst injury.
A comminuted fracture of the lumbar spine endplate (arrow) results in spinal
canal narrowing.

86. Lumbar spine trauma. Axial CT (right) and axial MRI (left) images of an upper
lumbar spine burst injury.
While the CT image presents better detail concerning the bone injury, the MRI
image fully illustrates the position of the conus

87. Lumbar spine trauma. A 35-year-old man presented to the emergency
department after a motor vehicle accident. He complained of back pain without
paresthesias or weakness of his lower extremities.
Findings on the sagittal T2-weighted MRI confirms edema in the posterior L1
vertebral body (white arrow), while stenosis is noted posterior and inferior to
the L1 (yellow arrow)

89. •Lumbar spine trauma. Lateral
radiograph demonstrates an L3 spinal
compression fracture.
•Note the downward compression of the
superior endplate of the L3 (yellow
arrow).
•The anterior portion of the L3 vertebral
body has been displaced forward (white
arrow).

90. Sagittal T2W
image of 23yr old
male showing
burst fracture
with anterior
wedging(arrow)
of L1 vertebra.

92. A 35-year-old man presented to the
emergency department after a motor vehicle
accident. He complained of back pain
without paresthesias or weakness of his
lower extremities.
Sagittal reformatted CT image
demonstrates fracture of the anterior L1
vertebral body with a posterior fragment
displaced into the spinal canal (black
arrow).
The fracture extended into the spinous
process (yellow arrow).
A second fracture in the L3 vertebral body is
noted in the posterior aspect of the inferior
endplate of the L3 (white arrow).

93. Sagittal T2-weighted MRI of an L2 compression
fracture. Relatively little deformity of the L2
vertebral body is shown, with less than 5° of
kyphotic forward angulation.
Compression fractures with little angulation
often are associated with significant posterior
ligamentous trauma (arrow).

94. Lumbar spine trauma. Sagittal T2-weighted
gradient-echo MRI demonstrates a
compression fracture of the L1 vertebral body
with a small bony fragment displaced into
the spinal canal

95. Lumbar spine trauma. Three-dimensional reconstruction of a CT scan of the
thoracic and lumbar spine in a patient with complex injury.
The L1 vertebral body is compressed with a severe rotation of the L1 vertebral body
under the T12. This injury was associated with a severe neurologic injury to the
conus and cauda equina

97. A Chance fracture or a modified
compression fracture of the upper lumbar
spine may occur when the weight of the
upper body moves forward (red arrow)
while the person's waist and upper body are
fixed in position by the seatbelt or steering
wheel of an automobile (pink arrows).
The resulting fixed-position stress results in
a fracture

99. Lumbar spine trauma. Sagittal reformatted
CT image in a patient with lumbar vertebral
body distraction (arrow).
Distraction injury commonly is associated
with injury to the conus of the distal spinal
cord

107. Thank You