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Thoracic Spine Fractures and Dislocations Workup

  • Author: Michael Leahy, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Nov 12, 2014
 

Imaging Studies

Anteroposterior (AP) and lateral radiographs of the thoracic spine are obtained initially to elucidate the fracture configuration. Radiographic evidence of a fracture at any level of the spine necessitates radiographic analysis of the entire spine.[8]

Computed tomography (CT) of the thoracic spine with sagittal reformatted images provides information about the extent of injury to osseous structures and posterior elements. Smith et al found that nonreconstructed CT detected thoracolumbar spine fractures more accurately than plain radiographs did and recommended CT for diagnosis of such fractures in acute trauma patients with altered mental status.[9] In their view, reconstructions need not be ordered unless there is an abnormality on the nonreconstructed CT scan that needs additional elucidation.

In a retrospective study of patients with acute fractures of the thoracic or lumbar spine who had also undergone an abdominal (or L1) CT scan, Emohare et al found that CT offered an inexpensive and convenient method for confirming a diagnosis of osteoporosis in patients with spinal fractures.[10]

Magnetic resonance imaging (MRI) is useful for evaluating soft-tissue injury to the ligaments, discs, and epidural spaces. MRI is most useful in patients when traumatic disc herniation, epidural hematoma, or spinal cord injury is suspected. In addition, MRI is used when CT and radiographic analysis do not adequately explain the patient's symptoms.[11]

 
 
Contributor Information and Disclosures
Author

Michael Leahy, MD Staff Physician, Department of Orthopedic Surgery, Baylor - All Saints Hospital, Harris Methodist Hospital of Fort Worth

Disclosure: Nothing to disclose.

Coauthor(s)

Mark Rahm, MD Chair and Associate Professor, Department of Orthopedic Surgery, Baylor Scott and White/Texas A&M Health Science Center College of Medicine, Scott and White Memorial Hospital

Mark Rahm, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, North American Spine Society, Texas Medical Association, Texas Orthopaedic Association

Disclosure: Received research grant from: institutional funds from K2M<br/>Received income in an amount equal to or greater than $250 from: Received royalty from SpineSmith.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Lee H Riley III, MD Chief, Division of Orthopedic Spine Surgery, Associate Professor, Departments of Orthopedic Surgery and Neurosurgery, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

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Thoracic spine fractures and dislocations. Burst fracture T12. Note the widened interpedicular distance.
Thoracic spine fractures and dislocations. Flexion distraction injury with facet dislocation.
Thoracic spine fractures and dislocations. Fracture dislocation T2-T3.
Thoracic spine fractures and dislocations. Preoperative axial CT image of burst fracture with partial neurologic deficit.
Thoracic spine fractures and dislocations. Burst fracture with partial neurologic deficit after stabilization with medial resection of right pedicle to allow access to anterior fragment.
Thoracic spine fractures and dislocations. Pedicle screw fixation of a T12 burst fracture.
Thoracic spine fractures and dislocations. Anteroposterior (AP) radiograph of T12 burst fracture treated with cage strut and anterior instrumentation.
Thoracic spine fractures and dislocations. Lateral radiograph of T12 burst fracture treated with cage strut and anterior stabilization.
 
 
 
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