Many patients are predisposed to thoracic spine fractures: including those with pathologic lesions, osteoporosis, chronic degenerative and/or inflammatory conditions which may result in weakened bones or altered biomechanics.
Patients with osteoporosis may present with multiple wedge compression deformities which may be of various ages. Comparison imaging or MRI will help determine acuity.
Look carefully for new compression deformities and/or further vertebral body height loss.
Certain degenerative and inflammatory diseases cause abnormal fusion across osseous structures including:
- Ankylosing spondylitis
- Diffuse idiopathic skeletal hyperostosis
- Ossification of posterior longitudinal ligament
Check for subtle disruption across any areas of confluent ossification with a low threshold to recommend CT.
Fractures often traverse multiple vertebral levels and disc spaces due to altered biomechanics and loss of mobility. They are often described as “chalk stick fractures”.
- Displaced discovertebral complex fracture involving T9 and T10 with obliquely oriented fracture plane extending from anterior confluent osteophytes of T9-10 to inferior endplate of T10 vertebral body near posterior cortex.
Disc degeneration is detected radiographically by disc height loss and endplate osteophyte formation.
- Normal thoracic kyphosis. Vertebral body heights and alignment are maintained.
- Multilevel degenerative changes, characterized mainly by disc height loss, endplate osteophytes, and lower thoracic facet arthropathy, most pronounced at T9-T10.