Thoracic spine fractures

Case contributed by Dr Patsy Robertson

Presentation

74 year old female, fell of bike at speed, thoracic and flank pain

Patient Data

Age: 74
Gender: Female
Modality: CT

There is T12 vertebral body compression with approximately 30% loss of height.

A fracture line extends in oblique axial plane through vertebral body, left pedicle, lamina, pars and base of spinous process.

Subtle fracture through the right T12 transverse process.

Trabecular distortion suggests undisplaced fracture through right pedicle. There is also a fracture through the tip of the T12 spinous process.

The T8 superior endplate compression fracture may be chronic.

The numerous gas locules posterior to right diaphragmatic crus and to right of aorta in lower mediastinum are geographically in proximity to the T12 vertebral body fracture.

Further tiny locules are noted adjacent to the fractured right T12 transverse process. Thee have likely tracked from the pleural cavity

In conclusion, 3 column spinal injury at T12.

Modality: MRI

MRI Thoracic Spine (trauma protocol)

At T12 there is a fracture line through the left side of the vertebral body in association with a marrow oedema pattern. No retropulsed bone fragments. Fracture is also seen in the right transverse process. 

Multiple other sites of a bone marrow oedema pattern are seen including within the T4 superior endplate, T9, and the L1 superior endplate.

At T9 there is loss of height of the superior endplate with oedema extending into the right pedicle at this level.

There is wedging of the T8 vertebral body without marrow oedema, indicating an old injury.

The vertebral canal is capacious at all levels. No epidural haematoma. Spinal cord signal is normal.

Bilateral pleural effusions are noted, larger on the left and moderate on the right associated compressive atelectasis of the underlying lungs.

Conclusion:

T12 three-column fracture . Changes at T4, T9 and L1 are suspicious for acute crush fractures. 

 

Case Discussion

The difficulty here initially was differentiating acute from chronic thoracic fractures in a 74 year old female. The presence of fracture lines and adjacent soft tissue changes helped at T12. MRI was required to show evidence of acute injury at T4, T9 and L1 best seen on the sagittal STIR images.  

However these were treated conservatively.

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Case Information

rID: 30047
Case created: 15th Jul 2014
Last edited: 24th Apr 2017
Inclusion in quiz mode: Included

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