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.
Each vertebral body should be similar in height to the adjacent vertebral body. Any degree of wedging and height loss may indicate compression fracture.
- 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.
- 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.
- 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.
- Comminuted fracture of T12 associated retropulsion, focal kyphosis and interspinous widening, suggesting flexion-distraction mechanism of injury.
- Recommend CT and MRI for further assessment.
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.
- ACR appropriateness criteria, suspected spine trauma
- Traumatic Thoracolumbar Spine Injuries: What the Spine Surgeon Wants to Know
- Bharti Khurana, Scott E. Sheehan, Aaron Sodickson, Christopher M. Bono, and Mitchel B. Harris RadioGraphics 2013 33:7, 2031-2046