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Thoracolumbar Spine Fractures in Patients Who Have Sustained Severe Trauma: Depiction with Multi–Detector Row CT¹

¹ From the Department of Diagnostic and Interventional Radiology (M.W., N.T., P.S.) and Department of Traumatology and Orthopaedics (E.M., P.M., P.F.L.), Centre Hospitalier Universitaire Vaudois, BH07, 1011 Lausanne, Switzerland; and Biostatistics Unit, Institute of Social and Preventive Medicine, Lausanne University, Switzerland (G.v.M.). Received May 17, 2002; revision requested July 16; final revision received November 15; accepted November 27. Address correspondence to M.W. (e-mail: Max_Wintermark@hotmail.com).

View larger version (142K): [in a new window]   Figure 1. Images in a 44-year-old woman who was involved in a high-speed car accident. No fractures are apparent on frontal (A) or lateral (B) radiographs. Sagittal (C) and transverse (D, E) thoracolumbar multi-detector row CT images demonstrate two spinal fractures (arrows in C), one involving the anterior column of T5 (arrow in D) and another the anterior column of T11 (arrow in E). Both fractures are easily and accurately located in C, while the transverse images in D and E demonstrate the integrity of the vertebral canal. The widening of the paraspinal soft tissues at T5-T6 on the right in A constitutes the only clue at radiography that a fracture might be present.

View larger version (150K): [in a new window]   Figure 2. Images in a 36-year-old man who was involved in a motorcycle accident. No unstable fractures can be seen on frontal (A) and lateral (B) radiographs. Sagittal (C) and transverse (D) thoracoabdominal multi-detector row CT images show fractures of the T3 and T4 vertebral bodies. D clearly demonstrates that the fractures abut the vertebral canal (arrow) and involve both the anterior and the middle columns and are hence unstable. A fracture of the proximal end of the right T3 rib (arrowhead) is also present. Insets show the plane of view in which the image was acquired.

View larger version (178K): [in a new window]   Figure 3. Images in a 34-year-old woman who fell from a 6-m height. Conventional frontal (A) and lateral (B) radiographs depict fractures (arrows in B) of the anterior column of the L2 and L3 vertebrae. Sagittal (C) and transverse (D) thoracoabdominal multi-detector row CT images confirm the presence of these fractures (arrows in C). A posteriorly displaced bone fragment (arrowhead in B, arrow in D) at the L3 level is more easily seen in D than in B. This fragment is responsible for a compromise of the vertebral canal, making the L3 fracture an unstable burst fracture, with repercussions for the patient’s treatment. Insets show the plane of view in which the image was acquired.

View larger version (97K): [in a new window]   Figure 4. Images in 48-year-old man who was involved in a high-speed car accident, during which he was ejected from his vehicle. Conventional frontal (A) and lateral (B) radiographs reveal an unstable Chance fracture (arrows in B) involving the anterosuperior endplate of the L3 vertebra and the L2 vertebral arch. Multiplanar two-dimensional reformats (C, D, F, G) and a three-dimensional surface-shaded multi-detector row CT image (E) demonstrate the same findings (arrows in C, E, and F). D, Transverse image enables accurate characterization of the fractured vertebral portions (left L2 pedicle, right and left L2 laminae, left L2 transverse process, right L3 superior articular facet). G, Coronal image also reveals a fracture of the left L2 inferior articular facet (arrow). Insets in D, E, F, and G show the plane of view in which each image was acquired.