Fri 30th Aug 2013
Session 2 / Talk 3
10:55 – 11:05
BROOKLYN 3
STUDENTS
Sophie PERYMAN
ABSTRACT
Traumatic spinal fractures are not particularly commonplace in emergency departments.
However, due to the risks of debilitation it is essential for patients to be accurately imaged
and diagnosed in order for the most appropriate treatment plan to put in place. This
paper will specifically discuss burst fractures: mechanism of injury, clinical signs, imaging
options (historical and current thinking) and prognosis.
Burst fractures account for 17% of all spinal fractures and due to their nature, are often
associated with compromise of the spinal canal to some degree.
With the rapid technological advances in imaging modalities, the options for imaging burst
fractures have evolved. In order to ensure best practice, consideration should be given to
choosing the most appropriate technologies instead of being tempted to use all of the
modalities.
This paper will explore the current multimodality approaches to imaging burst fractures in
order to demonstrate the essential role of the MIT in optimizing the patient pathway.
BURST FRACTURES
A Multimodality imaging approach
Sophie Peryman
Bachelor of Health Science (Medical Imaging)
Unitec
OVERVIEW
• Definition
• Mechanisms of injury
• Classification systems
• Imaging pathways
• Summary
ASIANIA AIRLINES CRASH
http://i2.cdn.turner.com/cnn/dam/assets/130706190825-san-francisco-plane-crash-18b-horizontal-gallery.jpg
ASIANIA AIRLINES CRASH
http://www.nydailynews.com/news/national/asiana-flight-214-pilots-realized-seconds-crash-approach-slow-article-1.1392535
ASIANIA AIRLINES CRASH
http://cdn-wac.emirates247.com/polopoly_fs/1.513667.1373338995!/image/3595643928.jpg
BURST FRACTURE DEFINED
• Failure of anterior
and middle margins
• Potential for
neurological damage
• Typical mechanisms
of injury
MECHANISMS OF INJURY
INTERVERTEBRAL DISKS
INTERVERTEBRAL DISKS
3-COLUMN CLASSIFICATION SYSTEM
Denis (1983)
• Anterior column
• Middle column
• Posterior column
Middle column considered
to be of paramount
importance to spinal
stability
THORACOLUMBAR INJURY CLASSIFICATION &
SEVERITY SCORE (TLICS)
Vaccaro (2005)
Based on three important injury characteristics:
1. Morphology of injury
2. Integrity of posterior ligamentous complex
3. Neurological status of the patient
CHOICE OF IMAGING MODALITY
Cassar-Pullicino & Tins (2006) claim the biggest
problem of imaging spinal injury patients is the
choice of the appropriate imaging modality in
the different stages of patient care.
CHOICE OF IMAGING MODALITY: XRAY
1. Severe compression of
vertebral body
1. Disruption of posterior
body line
1. Widening of
interpedicle distance
Abitol et al. (1992)
http://radiopaedia.org/articles/burst-fracture
CHOICE OF IMAGING MODALITY: XRAY
http://radiopaedia.org/articles/burst-fracture
CHOICE OF IMAGING MODALITY: CT
http://radiopaedia.org/articles/burst-fracture
CHOICE OF IMAGING MODALITY: CT
http://www.sciencephoto.com/image/426178/350wm/F0039177-Degenerative_disc_disease,_3D_CT_scan-SPL.jpg
CHOICE OF IMAGING MODALITY: MRI
http://images.radiopaedia.org/images/11026/5c06fbb2b629222ff83a9518915302.jpg
SUMMARY
REFERENCES
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Abitbol, J., Ballock, R., Cervilla, V., Garfin, S., Mackersie, R., & Resnick, D. (1992). Can burst fractures be predicted from plain
radiographs? The Bone & Joint Journal, 74, (1), 147 – 150. Retrieved from http://www.bjj.boneandjoint.org.uk/content/74B/1/147.full.pdf+html
Anderson, M., Kulstad, C., & Tuite, A. (2008). Thoracolumbar spine and pelvis plain radiography. In J. C. Fox (Ed.), Clinical Emergency
Radiology (pp. 106 – 116). New York City: Cambridge University Press.
Cowan, J & Rommey, L.. (2013). SF plane crash: injured suffer spinal injuries, internal bleeding. Retrieved from
http://www.latimes.com/local/lanow/la-me-ln-san-francisco-plane-crash-injured-suffer-spinal-injuries-internal-bleeding20130706,0,2189046.story
Daffner, R., Deeb., & Rothfus, W. (1987). The posterior vertebral body line: importance in the detection of burst fractures. Americal
Journal of Roentgenology, 148 (1), 93 – 96. Retrieved from http://www.ajronline.org/doi/abs/10.2214/ajr.148.1.93
Daffner, R. H., & Daffner, S. D. (2006). Vertebral Injuries: Detection and Implications. In V. N. Cassar-Pullicino & H. Imhof, Spinal Trauma
– An Imaging Approach (pp. 36 – 54). New York City: Theime.
Fox, J. C., & Habicht, M. E. R. (2008). CT of the spine. In J. C. Fox (Ed.), Clinical Emergency Radiology (pp. 404 – 419). New York City:
Cambridge University Press.
Fox, J. C., & Harries, A. (2008). MRI of the spine. In J. C. Fox (Ed.), Clinical Emergency Radiology (pp. 538 – 559). New York City:
Cambridge University Press.
Government of Western Australia. (2013). Diagnostic Imaging Pathways – Thoraco-Lumbar Spine Injury. Retrieved from
http://www.imagingpathways.health.wa.gov.au/index.php/imaging-pathways/musculoskeletal-trauma/bone-and-jointtrauma/thoraco-lumbar-spine-trauma#pathway
Mayfield Clinic. (2013). Anatomy of the Spine. Retrieved from http://www.mayfieldclinic.com/PE-AnatSpine.htm#.UhR47xZH2_t
OrthopedicsOne. (2012). Thorcolumbar burst fracture. Retrieved from
http://www.orthopaedicsone.com/display/Main/Thoracolumbar+burst+fracture
The USC Centre for Spinal Surgery. (2013). Thoracolumbar Spine Fractures. Retrieved from http://www.uscspine.com/conditions/spine-fractures.cfm
Tins, B., & Cassar-Pullicino, V. N. (2006). Optimizing Imaging Options. In V. N. Cassar-Pullicino & H. Imhof, Spinal Trauma – An Imaging Approach (pp.
36 – 54). New York City: Theime.
Rajasekaran, S. (2009). Thoracolumbar burst fractures without neurological deficit: the role for conservative treatment. Eur Spine J, 19 (1), 40 – 47.
doi: 10.1007/s00586-009-1122-6
Zbeblick, T. (2012). Burst Fractures: defined and diagnosed. Retrieved from http://www.spineuniverse.com/conditions/spinal-fractures/burstfractures-defined-diagnosed
Thank you for your attention!