Presentation
Construction worker. Fall over 20 feet. Back pain and sensory loss from thighs down.
Patient Data
Severe fracture of L2 vertebral body with narrowing of spinal canal.
Also bilateral transverse process fractures of L2 and small fracture of L3 body.
Disruption of vertebral alignment.
Acute fracture of L2 vertebral body with "retropulsion" causing narrowing of the spinal canal. This is impinging the spinal cord at the level of conus/start of the cauda equina. No change in cord signal.
Small corner fracture of L3.
Note: STIR acts to "suppress" fat allowing better visualization of other soft tissues and CSF space. The brightness in L2 is edema in an acute fracture.
Annotations of the key findings from the imaging.
Blue area - normal spinal canal
Red area - compressed spinal canal at fracture site
Case Discussion
This case illustrates the different roles that different imaging modalities play. The CT is useful in identifying bony injuries and other possible injuries (bleeds, abdominal trauma). However to properly evaluate the injury to the spinal cord and other soft tissues, MRI is the best modality.
This young man had spinal cord compression and underwent emergency neurosurgical decompression.
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Thanks to Dr Ian Bickle for contributing this case and his further discussion about different spinal fractures (original entry here).