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Traumatic Thoracic Spine

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Traumatic Thoracic Spine

Thoracic spine Trauma 1

Thoracic spine radiographs obtained after trauma should evaluate for fracture and malalignment. 

The three column concept is a simple way to subdivide the spine in traumatic injury:

  • Anterior column: anterior longitudinal ligament and anterior 2/3 of vertebral body and intervertebral disc.
  • Middle column: posterior 1/3 of vertebral body and disc and posterior longitudinal ligament.
  • Posterior column: pedicles, facet joints, ligamentum flavum, interspinous ligaments.
     
TraumaticTSpine2

Each vertebral body should be similar in height to the adjacent vertebral body. Any degree of wedging and height loss may indicate compression fracture. 

FINDINGS:

  • Compression deformity of the superior endplate of L1 with fracture extending into the posterior spinous process concerning for 3 column fracture.
  • Compression fracture of the Superior endplate of L2 with 15% estimated vertebral body height loss. 

 

 

 

Other fractures may also appear as subtle lucency, cortical step-offs, or cortical buckling. 
 

FINDINGS:

  • Comminuted fracture of L2 vertebral body resulting in superior endplate depression and mild anterior height loss.
  • Additional fractures of L1 with minimal anterior cortical buckling and fracture lucency extending through spinous process.
Thoracic spine Trauma 3

Example report:


FINDINGS:

  • Comminuted fracture of T12 vertebral body with extension of fracture planes to anterior and posterior cortex with slight retropulsion.
  • Focal kyphosis centered about T11-T12 with associated widening of the interspinous space posteriorly. 

IMPRESSION:

  • Comminuted fracture of T12 associated retropulsion, focal kyphosis and interspinous widening, suggesting flexion-distraction mechanism of injury.
  • Recommend CT and MRI for further assessment. 
Thoracic spine Trauma 4

Example report negative for traumatic injury:

FINDINGS: No compression deformity. Vertebral body heights and alignment are maintained. 

IMPRESSION: No traumatic malalignment or compression deformity. Radiographic sensitivity for thoracic spine injury is limited. Recommend cross-sectional evaluation if suspicion for injury persists.