SET T0033 -
Emergency Department -
Spine Trauma

Observations:

• Wedge compression fracture of the body of T11 vertebra.
• The anterior aspect of the vertebral body is disrupted.
• The posterior aspect of the vertebral body bulges posteriorly - into the vertebral canal.

Conclusions:

Two columns have been disrupted - ie the anterior and middle columns. This indicates an unstable injury.

[See the subsequent CT examination. The disruption of the two columns is well shown, and demonstrates a large fragment intruding into the spinal canal].

An explanation of the three column spine and assessing the radiographs for instability . . .

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 200-210

Normal appearances.

If you are relatively inexperienced in assessing the lateral radioraph, then . . . this lateral radiograph (a really excellent normal) can be used to test yourself in relation to asking - are all the C-spine lines and vertebral appearances normal? And - how can I assess the normal anatomy at the C1/C2 level? I am told that I will be helped with the analysis once I have identified the "coffee bean shadow".

Normal lines??  Coffee bean shadow??  .  .  .

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 172-179

Recap:

• The most useful C-spine view - following trauma - is the lateral radiograph.
• The open mouth peg view is also useful (particularly for assessing the lining up of the lateral masses).
• The AP radiograph is only occasionally the key radiograph in a three view series.

Observations:

• The lateral radiograph reveals a displaced fracture of the odontoid peg. [OA changes are prominent - not unusual in an 82 year old patient].
• See the lateral section obtained from the subsequent CT examination. The antero-posterior displacement of the peg fracture is confirmed.
• Note: the open mouth peg view does not show the peg fracture in this patient. This is not unexpected because cephalo-caudal displacement of a peg fracture is rare.

Lining up of the lateral masses??  .  .  .

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 173 and 180

Normal radiographs.