PURPOSE: To reassess the diagnostic value of plain radiographs, compared with computed tomography, in thediagnosis of acute traumatic spinal fracture. MATERIALS AND METHODS: Forty-six patients (total 64 cases) withacute traumatic spinal fracture were studied using plain radiographs and computed tomography. Fracture site andtype (according to the three-column theory), classification as major or minor injury, stability of fracture, andthe presence of associated soft tissue change were evaluated on plain radiographs and CT. The results of the twoimaging techniques were compared. RESULTS: Excluding eight cases of C1 and C2 fractures, 41 cases involvedfractures of the vertebral body, and 15 involved only the posterior column. Plain radiographs and CT showed,respectively, 27 and 25 cases of simple compression fracture, 13 and 16 of bursting fracture. One case ofcompression fracture was not detected on plain radiographs. The results of classification as major (43/56) orminor (13/56) injury were equivalent on plain and CT films. For the evalvation of unstable fracture, plainradiographs were superior to CT(stable fracture, 46/64; unstable fracture, 18/64), while for the evaluation ofsoft tissue change, CT was better than plain radiographs. CONCLUSION: If correct procedures are meticulouslyadhered to, plain radiographs of acute traumatic spinal injury provide good information for the diagnosis oftraumatic fracture.
Classification ; Diagnosis ; Fractures, Compression ; Humans ; Spinal Fractures* ; Spinal Injuries

Multiple non-contiguous spinal fracture is a special type of multi-level spinal injury, which is rare but most frequently occur in motor vehicle accident or a falling from a height. We report five patients of multiple non-contiguous spinal fractures. All patients underwent segmental pedicle screws fixation without fusion for preserving facet joints and minimizing blood loss and operation time. We performed necessary operation for any concomitant injuries at the same day.
Humans ; Motor Vehicles ; Spinal Fractures ; Spinal Injuries ; Spine ; Zygapophyseal Joint

We reported two cases of jockeys who sustained fracture/dislocation of the mid-thoracic spine due to traumatic falls during horse racing. We examined the injury mechanism based upon the patients' diagnostic images and video footage of races, in which the accidents occurred. Admission imaging of patient 1 (a 42 years old male) revealed T5 burst fracture with bony retropulsion of 7 mm causing complete paralysis below T5/6. There existed 22° focal kyphosis at T5/6, anterolisthesis of T5 relative to T6, T5/6 disc herniation, cord edema and epidural hemorrhage from T4 through T6, and cord injury from C3 through C6. Admission imaging of patient 2 (a 23 years old male) revealed T4/5 fracture/dislocation causing incomplete paralysis below spinal level. There existed compression fractures at T5, T6, and T7; 4 mm anterior subluxation of T4 on T5; diffuse cord swelling from T3 through T5; comminuted fracture of the C1 right lateral mass; right frontal traumatic subarachnoid hemorrhage; and extensive diffuse axonal injury. The injuries were caused by high energy flexion-compression of the mid-thoracic spine with a flexed posture upon impact. Our results suggest that substantially greater cord compression occurred transiently during trauma as compared to that documented from admission imaging. Video footage of the accidents indicated that the spine buckled and failed due to abrupt pocketing and deceleration of the head, neck and shoulders upon impact with the ground combined with continued forward and downward momentum of the torso and lower extremities. While a similar mechanism is well known to cause fracture/dislocation of the cervical spine, it is less common and less understood for mid-thoracic spine injuries. Our study provides insight into the etiology of fracture/dislocation patterns of the mid-thoracic spine due to falls during horse racing.
Accidental Falls ; Animals ; Horses ; Humans ; Joint Dislocations ; Male ; Spinal Cord Injuries/etiology* ; Spinal Fractures/etiology* ; Spinal Injuries ; Thoracic Vertebrae/injuries*

OBJECTIVE: The purpose of this study is to determine the factors that have effects on the neurological deficit in the patients with thoracolumbar fracture. METHODS: Forty-eight patients were included. Cause of injury, type of injury, time interval, combined injury, kyphotic angle, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, transverse diameter, the most narrow transverse diameter, and remained height of vertebra body were concerned as the factors. The patients with American Spinal Injury Association(ASIA) impairment scale grade A to D were considered as having neurology while others with ASIA grade E were considered to be without neurology. The patients with ASIA grade A were classified to paraplegia group and the patients with ASIA grade B to E were not thought to be paraplegia. Statistical analysis for these groups were performed. RESULTS: Spinal canal compromise (P<0.001) have correlation with neurological deficit. The most narrow sagittal diameter was smaller in the group with deficit than that in the group without deficit (P=0.004). Also, combined injury have correlation with neurology (P=0.028). Spinal canal compromise (P<0.001), sagittal diameter (P=0.032), the most narrow sagittal diameter (P=0.025), and Denis type (P<0.001) also have correlation with paraplegia. CONCLUSION: The factors of percentage of spinal canal compromise, the most narrow sagittal diameter, and combined injury are predictive of neurological deficit. The patients with paraplegia may be predicted by the factors such as type of injury, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, and Denis type.
Asia ; Humans ; Neurologic Manifestations ; Neurology ; Paraplegia ; Spinal Canal ; Spinal Fractures ; Spinal Injuries ; Spine

Subacute posttraumatic ascending myelopathy is a rare disorder, unrelated to syrinx formation or mechanical instability, which may gradually emerge within the first 1-2 weeks after a spinal cord injury and may lead to diagnostic and prognostic dilemmas. We present a case of 24-year-old female with unstable wedge compression fracture of L1 vertebrae with signal changes in the upper lumbar cord causing complete paraplegia below D9 with bladder and bowel involvement. In the subsequent week, she developed a delayed progressively increasing neurological deficit with cord signal abnormality on MRI extending cephalad from the injury site to the upper dorsal cord. The patient had no initial clinical improvement initially but showed a delayed recovery over months.
Adult ; Female ; Humans ; Spinal Cord Diseases ; etiology ; therapy ; Spinal Cord Injuries ; complications ; Spinal Fractures ; complications

OBJECTIVE: Percutaneous vertebroplasty is a minimally invasive procedure to relieve or decrease pain in patients with osteoporotic compression fractures. However, vertebroplasty in the osteoporotic burst fracture patients with preoperative canal encroachment are still being debated, because it can aggravate spinal canal encroachment. The objects of this study is evaluation of the changes in spinal canal narrowing after percutaneous vertebroplasty. METHODS: Inclusion criteria was osteoporotic bursting fracture patients with 5 to 20% canal encroachment (less than 5 mm). Exclusion criteria included pathological fractures, unstable vertebral fractures involving the posterior column, and severe neurological deficit. We measured the changes in spinal canal narrowing by pre- and postoperative computed tomography. Degree of canal encroachment was measured as the distance between the imaginary line along the posterior margin of the bony fragment and the maximal anterior imaginary line of the spinal canal in the axial CT scan. RESULTS: This study was based on 10 patients (1 male and 9 female; age range, 52-89 years; mean age, 75 years). The mean decrease in the compression rate of the vertebral body height was 14.4% (43.4% to 29%). The mean decrease in the kyphotic angle was 4.3degrees (11.7degrees to 7.4degrees). The mean preoperative canal encroachment were 3.5 mm and postoperative canal encroachment was 3.7 mm, respectively. The mean preoperative VAS score was 4.3 and postoperative VAS score was 1.4. CONCLUSION: Vertebroplasty can be a safe treatment option for osteoporotic burst fractures with preoperative minimal canal encroachment.
Body Height ; Fractures, Compression ; Fractures, Spontaneous ; Humans ; Kyphosis ; Male ; Osteoporotic Fractures ; Spinal Canal ; Spinal Injuries ; Vertebroplasty

PURPOSE: To determine whether there was a preponderance of a fracture type associated with early and late neurologic deterioration. MATERIALS AND METHODS: The review of all the surgically managed spinal fractures from October 1989 to July 1999 was performed. Of the 83 surgically managed patients, 39 had spinal cord injury. The other 44 patients in this consecutive series had no spinal cord injury. Charts, operative notes, preoperative and postoperative plain radiographs, computed tomography scans, and follow up records of all patients were reviewed carefully from the time of surgery until last follow-up assessment. The classification of Denis had been used prospectively for all patients before their surgery to determine the fracture morphology. Frankel Scale and American Spinal Injury Association Spinal Cord Injury Assessment Form(ASIA) were obtained during follow-up evaluation for all patients. RESULTS: All patients were observed over mean 57.4 months except 1 patient who died of pulmonary thromboembolism 1 week after surgery. In Denis classification, the most common injuries were burst fracture and fracture-dislocation. The degree of neurologic injury when first seen and at the latest follow up was different between burst fracture and fracture-dislocation. The extent of neurologic recovery was not different between burst fracture and fracture-dislocation. The fracture-dislocation was common in thoracic spine and the degree of neurologic injury was most severe in thoracic spine. Instead, the burst fracture was more common in lumbar spine and the degree of neurologic injury was relatively mild in lumbar spine. CONCLUSIONS: The severity of initial posttraumatic and the last follow up neurologic injuries were correlated with the fracture patterns by Denis classification, but the extent of neurologic recovery was not correlated with the fracture patterns by Denis classification. The lumbar fracture, injuring the cauda equina and the sacral nerve roots, shows greater recovery patterns than thoracic spine fractures.
Cauda Equina ; Classification* ; Follow-Up Studies ; Humans ; Pulmonary Embolism ; Spinal Cord Injuries ; Spinal Fractures* ; Spinal Injuries ; Spine

We present a series of 97 patients with spinal cord injury. Those patients were treated at Soonchunhyan University Chonan Hospital during six-year-period(January 1986-December 1992), and followed up for at least 3 months. They were divide into four groups ; complete-surgical, complete-conservative, partial-surgical, and partial-conservative. Male to female ratio was 3.6:1, and the peak age was the fifth decade. Passenger's traffic accident(46%) was the most common cause of injury and fall/slip(39%) followed next. Level of spinal injury was cervical in 51%, thoracic in 29%, lumbar in 13%, and others in 7%. Type of injury was fracture-dislocation in 31%, dislocation in 19%, compression fracture in 19%, burst fracture in 18%, cord injury without bony lesion in 7%, and others in 7%. Cord injury was complete in 36 patients(37%) and partial in 61 patients(63%). Surgery was performed in 20 patients with complete cord injury and 34 patients with partial injury. Majority of operations were performed for spinal stability, and posterior instrumentation was the most commonly used operative method. The mean neurotrauma motor index on admission was 44.1 in the complete-surgical group, 39.5 in complete-conservative group, 70.1 in partial-surgical group, and 63.2 in partial-conservative group. It improved to 52.5, 50.3, 90.4, 80.3 at 3 months, and 53.4, 51.7, 91.8, 82.0 at final examination(mean follow-up period was 182.2 days), respectively. The mean values of the final index were higher in the surgically treated groups than the conservatively treated groups, but these differences were not statistically significant(student t-test p>0.1) The mean recovery rate was 14.2% in the complete-surgical group, 17.7% in complete-conservative group, 66.1% in partial-surgical group, and 46.1% in partial-conservative group at 3 months. It improved to 16.6%, 19.3%, 70.0%, and 48.7% at final examination, respectively. The mean recovery rates were higher in the partially injured groups than the completely injured groups(student t-test, p<0.01), regardless the methods of treatment. The final neurotrauma motor index was significantly(regression analysis, p<0.01) related to the initial index except the partial-surgical group. Neurotrauma motor index was a useful method for assessing the injury severity, comparing the recovery rate and predicting prognosis.
Chungcheongnam-do ; Dislocations ; Female ; Follow-Up Studies ; Fractures, Compression ; Humans ; Male ; Prognosis* ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries

Injury to a lumbar disc is rare, and is seldom mentioned in the literature describing spinal fracture; even in patients with such fractures, disc herniation is infrequent and is often considered to be a sequella of trauma. Using magnetic resonance imaging(MRI) we investigated the incidence and pattern of disc injuries by an in 37 patients with fractures of the lumbar and thoracic spines. Discs adjacent to the fracture site were found to be normal in 19 patients(51.4%), but in ten(27.0%), the end plate was disrupted. The disc was ruptured in six patients(16.2%), and had degenerated in two patients(5.4%). Injured discs were found in the three patients with fracture-dislocation and three of the seven(42.9%) with burst fracture, but in none of the 27 with compression fracture. The three lower lumbar discs(L3-4, L4-5, and L5-S1) were found to be normal in 26 patients(70.3%), but had degenerated in seven(18.9%). Incidental asymptomatic disc herniation was found in four patients(10.8%), including one with degenerative spondylolisthesis. There was no traumatic disc herniation in the lower lumbar region. These results suggest that traumatic lumbar disc herniation is quite uncommon, even in the unstable thoracolumbar spinal injuries.
Fractures, Compression ; Humans ; Incidence ; Lumbosacral Region ; Magnetic Resonance Imaging* ; Spinal Fractures ; Spinal Injuries ; Spine* ; Spondylolisthesis

The accurate diagnosis of spine trauma is essential to its proper management, since therapeutic decisionsdepend on radiography and clinical data. Failure to recognize significant injury to the spine can lead to severeneurological deficit in the previously neulogically intact patient. The developmemt of CT has open a new demensionin evaluation of spinal column. In our experience CT not only offer the accurate and thorough evaluation of spinalinjury, but does so in a rapid and more efficient manner when compared with conventional radiolgraphy. CT hasbecome the diagnostic procedure of choice when screening plain film and clinical examination indecate that acomprehensive radiographic evaluation is necessary. Eighteen patients with thoracic and lumber spinal fracturewere studied with CT. Four had multiple level injuries. The resuls are summerized as follow; 1. Among the 18patients, 4 had multiple level injuries and other 14 patients had single spinal injury. 2. 8 patients (11 spines)had simple compression fracture and 12 patients (13 spines) had burst fracture of vertebral body. 3. 15 spinesamong the 24 involved spines are located at T12 and L1 level. 4. Spineal canal narrowing and bony fragment in thecanal are defiend only 7 of 13 spines (53.8%) of burst fracture in conventional radiography. However CT showed inall spines of burst fracture. 5. Spinal posterior element involvement is suggested only one of 12 spines of burstfracture, but correctly interpretated by CT in 7 spines(11 anatomical position).
Diagnosis ; Fractures, Compression ; Humans ; Mass Screening ; Radiography ; Spinal Fractures ; Spinal Injuries ; Spine