Ct spine fractures ppt
- 1. SPINAL INJURIES AND ITS CT CORRELATIONS PRESENTED BY: DR.B.BORTHAKUR PROFESSOR AND HEAD DEPT.OF ORTHOPAEDICS
- 2. Types of Craniocervical Injury
- 5. Type I odontoid fracture
- 6. Type II odontoid fracture
- 7. Hyperflexion Rotation Injury • A rotational force applied along with flexion can result in a unilateral dislocation of a facet joint. • The key conventional radiographic feature is the demonstration of a rotational abnormality at a single level. • CT demonstrates the ‘reverse hamburger’ sign on the axial sections through the facet dislocation. • The use of CT in this injury has demonstrated that a dislocation of the facet joint is frequently associated with a fracture of the joint and that these are not usually purely ligamentous injuries as previously thought.
- 8. Unilateral facet joint dislocation
- 10. AOSpine (Arbeitsgemeinschaft für Osteosynthesefragen Thoracolumbar Spine Injury Classification System Morphology Classification Type A. Compression injuries • A0. No fracture of the vertebra or insignificant fractures of the spinous or transverse processes • A1. Wedge compression of impaction fractures with fracture of a single end plate without involvement of the posterior wall of the vertebral body • A2. Split- or pincer-type fractures in which the fracture line involves both end plates but does not involve the posterior vertebral wall • A3. Vertebral fractures affecting a single end plate with any involvement of the posterior vertebral wall and spinal canal • A4. Vertebral body fractures involving both end plates as well as the posterior wall. Split fractures that also involve the posterior vertebral body are included in this group.
- 11. SUPERIOR END PLATE FRACTURE
- 12. AXIAL VIEW AND SAGGITAL VIEW OF VERTEBRAL BODY FRACTURE
- 13. Type B :Injury affecting either anterior or posterior tension band; may be seen in combination with type A fractures of the vertebral body • B1. Mono segmental osseous failure of the posterior tension band extending into the vertebral body, known as Chance fractures. • B2. Disruption of the posterior tension band with or without osseous involvement • B3. Disruption of the anterior longitudinal ligament, which serves as the anterior tension band of the spine, preventing hyperextension. The injury may pass through either the intervertebral
- 15. • Type C. Injuries characterized by displacement beyond the physiologicnrange of the cranial and caudal parts of the spinal column in any plane .
- 17. Burst Fractures • A burst fracture results from an axial compressive force through the spine. • This is one of the commonest thoracic and lumbar spine fractures and can also occur in the cervical spine if a force is applied to the top of the head without significant neck flexion or extension. • In the thoracic and lumbar spine a typical mechanism is a fall from a height and there is an association with bilateral calcaneal fractures. • The vertebral body, pedicles and posterior bony structures constitute a bony ring so that there is commonly a fracture through the posterior elements in addition to the burst fracture of the vertebral body
- 18. Thoracolumbar Spine Injury Classification and Severity Scale
- 19. Morphology of Injury Compression (value point 1) • Compression injuries are caused by axial loading or lateral flexion and are defined by imaging as variable loss of vertebral body height or disruption of the vertebral end plate. • Less severe injuries affect only the anterior portion of the vertebral Burst (value point 2) Axial loading or lateral flexion injuries with increased force result in burst morphology with involvement of theposterior body and varying degrees of retropulsion.
- 20. Translation or rotation (value point 3) • Torsional and shear forces cause horizontal displacement or rotation of one vertebral body with respect to another. • Imaging in the AP plane demonstrates horizontal separation of the spinous processes or altered alignment of the pedicles above and below. • The sagittal plane better depicts the facet fractures and dislocations. • In the axial plane, shifts across the sagittal plane can be observed across the injury site
- 21. Distraction (value point 4) • In distraction injuries one part of the spinal column is separated from the other, leaving a space in between. • This can occur through disruption of anterior or posterior ligaments, through anterior or posterior bony elements, or a combination of both. These are often very unstable injuries because by definition, the spinal column is disrupted circumferentially.
- 22. Neurologic Status • Intact (value point 0) • Nerve root involvement (value point 2) • Spinal cord or conus medullaris injury incomplete (value point 3) • Spinal cord or conus medullaris injury complete (value point 2) • Cauda equina syndrome (value point 3)
- 23. Integrity of the Posterior Ligamentous Complex. In the TLICSS the PLC includes the supraspinous ligament, interspinous ligament, ligamentum flavum, and facet joint capsules. • Intact (value point 0) • Injury suspected or indeterminate (value point 2) • Injured (value point 3). Injuries to the disk, anterior longitudinal ligament, and posterior longitudinal ligament are not scored as a part of the PLC but taken into account in the analysis of the morphology of the injury
- 25. • L5 spondylolytic defects (dashed black circle).
- 26. OPLL. This 77-year-old white man had slowly progressive myelopathy on clinical examination. Lateral radiograph (A) demonstrates OPLL in the upper cervical spine;
- 27. • Multilevel Schmorl nodes
- 28. • Impaction fractures involving the dome (A), femoral head (arrow, B), and posterior wall (arrow, C) all • confer a poor prognosis. In (A), dome impaction gives a characteristic gull-wing appearance formed by the intact • dome, and medial hollow at the site of impaction (blue outline). (
- 29. • A 26-year-old man following motor vehicle collision with comminuted posterior wall fracture and posterior hip dislocation(A). Intra-articular fragments dragged into the joint during emergent reduction (B).
- 31. Normal cervical spine imaging. (A) CT acquisition is performed with the patient in a cervical collar (arrow) with the head flat on the CT table (arrowheads) in neutral position. (B) Transaxial CT image through the vertebral ring with intact bone surrounding the spinal canal (dashed ring). (C) Transaxial CT image through the level of the facets with normal uniform appearance (arrowheads). (D) Midsagittal CT image outlining the anterior vertebral body line (solid line), posterior vertebral body line (larger dashed line), and spinolaminar line (smaller dashed line). The normal basion dense interval (BDI) measures <9.5 mm, and the normal atlanto odental interval (AOI) is <3 mm in adults (arrowheads). (E) Parasagittal reformation demonstrates the normal atlanto occipital interval (AOI) (< 1.4 mm) between the occipital condyles (OC) and the lateral mass of C1. Arrows point to parallel normal facet joints. (F) Coronal reformation through the upper cervical spine shows the normal relationship between the OC and the lateral masses of C1.
- 32. Atlanto-occipital distraction. (A) Midsagittal CT reformation shows an increased basion dense interval (BDI measures <9.5 mm) and the normal atlantodental interval. (B) Parasagittal CT image shows severe widening and lack of congruence of the atlanto occipital interval (AOI) . (C) Transaxial CT image through the craniocervical junction demonstrates extensive hemorrhage within the spinal canal surrounding the spinal cord (arrowheads).
- 33. C1 (atlas) fractures. (A) Transaxial CT image of a Jefferson fracture characterized by 2 anterior and 2 posterior arch fractures (arrowheads). There is no significant C1-C2 subluxation. (B) Jefferson variant fracture with right-sided fractures of the anterior and posterior arches and left tubercle (arrowheads). Note the lateral subluxation of the right lateral mass fracture fragment (arrow) indicative of instability.
- 34. TL-spine anatomy. (A) Midline sagittal images of the TL spine. The anterior vertebral line (solid line), posterior vertebral line (dashed line), and spinolaminar line (dotted line) should be smooth and continuous, without step-offs. The interspinous distances should be uniform (brackets). (B) Coronal images of the TL spine. The lateral vertebral lines (solid line) should be smooth, without step-offs. The interpedicular distances should be uniform (dotted line). The spinous processes should be aligned (dashed lines). (C) Parasagittal images. All facets should be fully covered and parallel (black lines). The superior (1) and inferior (2) articular processes of the facets, pedicles (3), and pars interarticularis (4) should be intact. (D) Transaxial images. The posterior vertebral body (dashed line), laminae (1), and pedicles (2) should form an intact ring at each level. The transverse processes should be intact (TP).
- 35. Transaxial CT shows a mildly displaced fracture of the left transverse process of L2
- 36. compression fracture. (A) Sagittal CT reformat shows a superior wedge compression fracture of L2 involving the superior endplate and anterior vertebral body wall (arrow). Note the intact posterior vertebral body wall (dotted line) and inferior endplate (dashed line). (B) Transaxial CT shows the fracture involving the anterior vertebral body and anterior cortex (arrowheads), sparing the posterior vertebral body wall (dotted line). (C) Sagittal CT reformats show a mildly depressed superior endplate impaction fracture of a lumbar vertebral body (arrow), sparing the posterior vertebral body wall (dotted line).
- 37. split fracture with endplate depression. (A) Sagittal CT reformat shows a coronally oriented fracture involving the superior and inferior endplates with mild superior endplate depression (arrows). Note the intact posterior vertebral body wall (dotted line). (B) Transaxial CT shows the coronal orientation of the fracture (arrowheads) with a component that involves the anterior vertebral body wall (arrow). Note the intact posterior vertebral body (dotted line).
- 38. complete burst fracture. (A) Sagittal CT reformat shows fractures of both the anterior and the posterior vertebral body walls with osseous retropulsion (arrowhead). The fracture involves both the superior and inferior endplates (arrows). There is mild kyphotic angulation (asterisk) without interspinous widening. (B) TransaxialCT shows fracture involvement of the posterior vertebral body wall (arrowhead) and bilateral pedicles (arrows).(C) Transaxial CT shows a nondisplaced vertically oriented fracture of the left pedicle (arrow) and a nondisplaced fracture of the left transverse process (arrowhead). (D) Coronal CT reformat shows a vertically oriented nondisplaced fracture of the left lamina (arrow).
- 39. incomplete burst fracture. Sagittal CT reformat shows a mildly retropulsed fracture of the posterior vertebral body wall (arrowhead). The fracture only involves the superior endplate (arrow).
- 40. THANK YOU