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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.
Thoracic spine Trauma 2

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.
Thoracic spine Trauma 3

Example report:


  • 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. 
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.