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Abstract
An accurate assessment of injuries to the spinal column and the neural tissues will facilitate the management of patients with injuries to the thoracic and lumbar spine. Routine radiological investigations are essential, but newer techniques are now available that define the extent of injuries in exquisite detail, providing a better understanding of not only the bony injuries, but also the extent of the soft tissue lesion, including the nervous system. The referring physician and the radiologist have many imaging techniques available for the diagnosis of the extent of thoracolumbar spine fracture. These include plain film radiography, computed tomography(CT), conventional polydirectional tomography, bone scan, magnetic resonance image(MRI), and myelography. These techniques are used alone or in combination to arrive at the correct diagnosis. It behooves the examining physician to be extremely thorough in identifying additional lession, not only for medicolegal reasons, but also to ensure that other potentially unstable lesions are not overlloked, since this could lead to neurological compromise if unsuspected. We describe the integrated use of multiple imaging techniques.
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Figures and Tables%
Fig. 1.
Wide gap between spinous processes in the AP(flexion-distraction) (A) and lateral(dislocation) (B) views that means posterior column injury.
Fig. 2.
Sagittal reconstruction view is useful in the evaluation of the canal encroachment, preoperatively (A) and canal clearance postoperatively (B).
Fig. 3.
3D reconstruction view is useful only in the malalignment (A) but subtraction technique can demonstrate canal encroachment (B).
Fig. 5.
Several patterns of retropulsed fragments in the CT. A. single central. B. sagittal split. C. comminution. D. asym-metric. E. reverse cortical sign(arrows) that means rupture of the posterior longitudinal ligament.
Fig. 8.
MR is superior to any other imaging modalities in evaluation of the posterior ligament complex injury(black arrow). And also is the only method of direct visualization of the nerve injury(white arrow).
Table 1.
MR signal changes in vertebral trauma
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