What to do if the spine x-ray shows a ---? – Part 1
- 1. What to do if the spine x-‐ray shows a … Dr Paul Licina Dr Greg Cowderoy Spine surgeon Radiologist
- 2. MVA with Flexion Injury Report : Alignment is satisfactory. Small fracture at the anterior corner C3. Disc degeneration and narrowing C3 –C6.
- 3. Flexion Teardrop Fracture Posterior ligament disruption and anterior compression fracture of the vertebral body which results from a severe flexion injury. Best seen on lateral view Signs: Prevertebral swelling associated with anterior longitudinal ligament tear. Teardrop fragment from anterior vertebral body avulsion fracture. Posterior vertebral body subluxation into the spinal canal. Spinal cord compression from vertebral body displacement. Fracture of the spinous process.
- 4. 45 yr M Axial injury onto head off mountain bike C/O neck pain at coffee after the ride Otherwise well
- 6. Bilateral Facet Dislocation Anterior dislocation of the vertebral body resulting from extreme hyperflexion injury. It is associated with a very high risk of cord damage. Best seen on lateral view Signs: Anterior dislocation of affected vertebral body by half or more of the vertebral body AP diameter. Disruption of the posterior ligament complex and the anterior longitudinal ligament. "Bow tie" or " bat wing" appearance of the locked facets.
- 10. Unilateral Facet Dislocation Facet joint dislocation and rupture of the apophyseal joint ligaments resulting from rotatory injury of the cervical vertebrae. Best seen on lateral or oblique views Signs: Anterior dislocation of affected vertebral body by less than half of the vertebral body AP diameter. Discordant rotation above and below involved level. Facet within intervertebral foramen on oblique view. Widening of the disk space.
- 12. 30 yr M Persisting pain 3 weeks after MVA. Neck stiffness No Neurology X-ray – Mild acute angle kyphosis at C5/6 with widening of the interspinous distance. No fracture is seen.
- 13. IMG_2085.JPG
- 14. Hyperflexion Injury Disruption of the posterior ligamentous complex resulting from hyperflexion. Signs: Loss of normal cervical lordosis. Anterior displacement of the vertebral body. Fanning of the interspinous distance.
- 16. C/O Neck Pain following preseason rugby camp.
- 18. Clay Shoveler’s Fracture Fracture of a spinous process C6-T1 Best seen on lateral view Signs: Spinous process fracture on lateral view. Ghost sign on AP view (i.e. double spinous process of C6 or C7 resulting from displaced fractured spinous process).
- 19. 40 yr male • Lumbar back pain following mountain bike accident • No radiculopathy • Tender mid lumbar spine
- 20. Report: Mildly displaced fractures of the left transverse processes of L2 and L3. No other fracture identified.
- 21. Crush Fractures And yet another fall in the making! • Mechanism • Low Energy- Osteoporotic Elderly • High Energy- All ages. Need to exclude more significant injury – Burst fracture -- Chance fracture
- 22. Crush Fractures
- 27. Burst Fracture Fracture that results from axial compression. Burst fracture is a type of compression fracture which results in disruption of the posterior vertebral body cortex with retropulsion into the spinal canal. When involves the thoracolumbar level, it tends to occur between T9 and L5 levels . Burst fractures may be stable or unstable. CT and MR is required for all patients to evaluate extent of injury.
- 28. Flexion Injury on holidays Severe thoracolumbar back pain and tenderness No radiculopathy Haematuria
- 31. Chance Fracture
- 33. PERCUTANEOUS VERTEBROPLASTY INDICATIONS Painful crush fracture Osteoporosis Few weeks Malignant crush fracture Biopsy + vertebroplasty Haemangioma Galibert 1987
- 34. PERCUTANEOUS VERTEBROPLASTY PATIENT SELECTION is the key to success Back pain Sudden onset May radiate anteriorly NOT sciatica Mechanical Restricted activity Poor sleep Local tenderness
- 35. PREPROCEDURE IMAGING Purposes of pre-procedure imaging: Confirm presence of crush fracture Confirm that crush fracture is acute/ununited Diagnose other acute levels Integrity of spinal canal Accurately localise level
- 36. MRI PRE- VERTEBROPLASTY Sagittal plane T1 for anatomy T2 fat saturation or STIR Marrow black Oedema white
- 37. MRI 2 3 2 3
- 40. CEMENT INJECTION
- 41. PERCUTANEOUS VERTEBROPLASTY LITERATURE Amar Neurosurg 2001;49:1105 97 pat., 258 levels ‘better life’ 74% Narcotic/analgesic use Mobility Better sleep Evans Radiology 2003;226:366 488 pat, 245 follow-up Pain scale 8.9 → 3.4 Impaired ambulation: 72% pre → 28% post N Engl J Med. 2009 Aug 6;361(6): 557-68. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. No benefit of vertebroplasty compared with a placebo procedure
- 42. PERCUTANEOUS VERTEBROPLASTY LOCAL RESULTS Sept 2001 – June 2004 131 procedures 112 patients F 78, M 34 Ages 58-94, average 76 186 levels ‘Complete’ response 73.3% Moderate response 17.6% No response 9.2%
- 43. Scoliosis Classification: Idiopathic: 80% Infantile <3; Juvenile 4-10; Adolescent: 10-18 Or: Early onset <5; Late onset >5 Congenital: Osteogenic: hemivertebra, fused vertebra Neurogenic: tethered cord, syringomyelia, Chiari Developmental: Achondroplasia NF OI Neuromuscular: Cerebral palsy Tumour: Osteoid osteoma BPNST