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Thoracic Spine, Trauma: Multimedia
Updated: Mar 23, 2007
Multimedia
 | Media file 1: Thoracic spine trauma. Drawing of the thoracolumbar spine viewed from an oblique frontal projection. SC indicates the spinal cord; NP, nucleus pulposus; VB, vertebral body; AF, annulus fibrosis; VNR, ventral nerve root; SN, spinal nerve; TP, transverse process; DNR, dorsal nerve root; and NRG, nerve root ganglion. |
 | Media file 2: Thoracic spine trauma. Axial drawing of a typical thoracic vertebral body viewed from above. The thoracic vertebral bodies are unique in that ribs articulate by rib facets (red outline and red arrow) with the correspondingly numbered vertebrae. The superior articular facet (outlined in blue, blue arrow) is oriented along a lateral plane. |
 | Media file 3: Thoracic spine trauma. Drawing of a typical thoracic vertebral body viewed in a lateral projection. The superior rib facet, semilunar inferior rib facet and the costal facet provide articulation for the ribs. The articular facet surfaces are oriented laterally. The spinous processes of the upper and mid thoracic vertebrae are angulated caudally. |
 | Media file 4: Thoracic spine trauma. Sagittal drawing of the thoracic spine demonstrating the structures that comprise the anterior, middle, and posterior columns. ALL indicates the anterior longitudinal ligament; AF, annulus fibrosus; NP, nucleus pulposus; PLL, posterior longitudinal ligament; SSL, supraspinous ligament; LF, ligamentum flavum; and ISL, interspinous ligament. Lateral drawing of the 3 spinal columns of the thoracolumbar junction. The anterior column is indicated by the black dotted line and includes the anterior spinal ligament, the anterior annulus fibrosis and the intervertebral disk, and the anterior two thirds of the vertebral bodies. The middle column (red dotted line) includes the posterior aspect of the vertebral bodies, the posterior annulus fibrosis, and the posterior longitudinal ligament. The posterior column (blue dotted line) includes all of the spine posterior to the longitudinal ligament (thick blue dotted line). |
 | Media file 5: Thoracic spine trauma. Twelve similar thoracic vertebral bodies form the thoracic spine. A rib is attached to each of the vertebral bodies of the same number. The mild kyphosis of the thoracic spine occurs due to the slightly wedged shape of the anterior thoracic vertebral bodies. |
 | Media file 6: Thoracic spine trauma. Posterior drawing of the lower thoracic spine. The last rib usually is attached to the 12th thoracic vertebral body. Each thoracic vertebral body articulates with a rib. The facet joints of the thoracic region are oriented in an anterior to posterior direction. The first lumbar vertebral body (blue arrow) is similar to the last thoracic vertebral body (black arrow) except for the absence of a rib at T12. |
 | Media file 7: Thoracic spine trauma. Lateral drawing the spine with the natural spinal curves shown by a curved line. A normal lordotic curve of the cervical spine, a mild kyphosis of the thoracic spine, and lordosis of the lumbar region are noted. These curves act to distribute the vertical weight-bearing load most efficiently. |
 | Media file 8: Thoracic spine trauma. The natural lordotic curvature of the cervical spine is reversed in the upper thoracic spine to form a kyphosis in the T1-T2-T3 segments in most adults. |
 | Media file 9: Thoracic spine trauma. Lateral radiograph of the thoracic spine of a 74-year-old woman. The kyphosis of the thoracic spine is related to osteoporotic failure of the T8 vertebral body. Note the 30-40% wedge-shaped deformity of the T8 vertebra. |
 | Media file 10: Thoracic spine trauma. Lateral 3-dimensional maximum intensity projection CT scan of multiple upper thoracic and lower cervical spinous process fractures. The force necessary to fracture the spinous processes of the upper thoracic spine may also involve the lower cervical spine. |
 | Media file 11: Thoracic spine trauma. Lower cervical spine facet fracture (same patient as in Image 5). Multiple spinal injuries may occur in a single patient due to the similarity of the mechanisms of injury that affect the lower cervical spine and the upper thoracic spine. |
 | Media file 12: Thoracic spine trauma. Three-dimensional CT scan of complex midface fractures including a Le Fort I injury in a patient who had fractures of the upper thoracic and lower cervical spinous processes (same patient as in Images 5-6). Sudden deceleration of the face and skull resulted in severe stress forces on the spinous processes. |
 | Media file 13: Thoracic spine trauma. Anteroposterior view radiograph of the lumbar spine demonstrates a narrowed T12 vertebral body height (arrow) consistent with a compression fracture. |
 | Media file 14: Thoracic spine trauma. Lateral radiograph of the lumbar spine. In the upper portion of the lumbar radiograph, a T12 compression fracture (arrow) is demonstrated. Superimposed lung and rib shadows make full depiction of the fracture difficult. |
 | Media file 15: Thoracic spine trauma. Lateral radiograph of the thoracic spine with compression fracture (arrow) centered in the image. The radiograph demonstrates a 40% anterior compression of the vertebral body. |
 | Media file 16: Thoracic spine trauma. Lateral radiograph of the lumbar spine in a patient with chronic renal disease. Metabolic bone disease, such as renal osteodystrophy (arrow), results in more frequent and more severe compression fractures. |
 | Media file 17: Thoracic spine trauma. Axial CT scan of a T12 compression fracture demonstrates a fracture line through the anterior body of the T12 (white arrow), posterior displacement of the T12 vertebral endplate (black arrow) into the spinal canal, and a fracture of the left transverse spinous process. |
 | Media file 18: Thoracic spine trauma. Axial and sagittal CT images of an acute lower thoracic spine compression fracture. Note the paraspinal hematoma (white arrows) and the slight narrowing of the spinal canal at the level of the compression fracture (double yellow arrows). |
 | Media file 19: Thoracic spine trauma. Three-dimensional CT scan of the thoracic spine demonstrates a compression fracture. |
 | Media file 20: Thoracic spine trauma. Drawing of a Chance fracture of the thoracic lumbar junction. The defect follows an irregular horizontal plane (arrows), which results in disruption of the anterior (black dotted line), the middle column (red dotted line), and the posterior column (blue dotted line). |
 | Media file 21: Thoracic spine trauma. Sagittal MRIs in a patient with acute spinal injury resulting from a motor vehicle accident. A, Fast spin-echo MRI demonstrates a combined fracture compression of vertebral bodies of T8 and T9. A small fragment of bone compromises the spinal canal and is in contact with the spinal cord. B, Gradient-echo T2-weighted image better defines the bone fragment within the canal (arrow). This fracture was associated with a partial spinal cord injury in which loss of motor function occurred with preservation of distal sensory function. |
 | Media file 22: Thoracic spine trauma. Anterior view of multiple spinal cord contusions caused by burst compression fractures of the middle and lower thoracic spine. |
 | Media file 23: Thoracic spine trauma. Sagittal CT scan of the thoracic and lumbar spine demonstrates a complete distraction fracture at the L1-2 interspace (arrow). |
 | Media file 24: Thoracic spine trauma. Drawing illustrates the mechanism of injury causing a Chance fracture. |
 | Media file 25: Thoracic spine trauma. Axial CT image of an unstable fracture of the thoracic spine. Note the association of compression of the vertebral body with laminar and pedicle fractures. Injury to the anterior, middle, and posterior columns results in an unstable fracture. |
 | Media file 26: Thoracic spine trauma. Coronal multiplanar reformatted CT images of an unstable thoracic spinal fracture. The association of both anterior compression and lateral subluxation (arrows) indicates instability. |
 | Media file 27: Thoracic spine trauma. Sagittal MRIs of the thoracic spine in a patient who had a complete spinal cord injury. A, Sagittal fast spin-echo T2-weighted MRI demonstrates disruption of the anterior longitudinal ligament (white arrow) and a wide distraction of the T9-T10 facets joints (yellow arrow). The spinal cord between T8-T9 and T9-T10 is disrupted with poorly defined margins. B, Sagittal gradient-echo T2-weighted MRI demonstrates the ligamentous injuries anteriorly (white arrow) and posteriorly (black arrow). |
 | Media file 28: Thoracic spine trauma. Sagittal T1-weighted MRI image of a compression fracture of the lower thoracic spine. The forces causing a Chance fracture include vertical loading and forward rotation around a fixation point, which often is a seatbelt. |
 | Media file 29: Thoracic spine trauma. Gradient-echo T2-weighted sagittal MRI image of a compression fracture. The T12 vertebral body has lost vertical height (white arrow). The spinal canal has been narrowed. Note the disruption of the posterior spinal ligaments (black arrow). |
 | Media file 30: Thoracic spine trauma. Chance fracture of the T12 resulting in lower thoracic cord injury. Note the edema of the lower thoracic spinal cord (arrow) resulting from the T12 fracture and the associated hyperflexion injury. |
 | Media file 31: Thoracic spine trauma. Axial T1-weighted MRI image of the thoracic spine in a patient with a burst injury of the T12 vertebral body. A large bone fragment has entered the spinal canal resulting in posterior displacement of the conus (arrow). |
 | Media file 32: Thoracic spine trauma. Volume maximum intensity projection CT image of the entire thoracic spine demonstrates spinous process fractures of the C7 through T7 vertebra. Although spinous process fractures of the T1 may occur in a manner similar to a clay shoveler's fracture of the C6 or C7, middle and lower thoracic spinous process fractures most likely occur due to a combination of forward flexion and axial rotation. Note the lack of findings of compression vertebral body fractures. |
 | Media file 33: Thoracic spine trauma. Three-dimensional surface CT image of the cervical spine (same patient as in Image 24). Note the spinous process fractures of the C6, C7, and T1. CT examination of both the cervical and the thoracic spine was obtained as a single study using a multisection CT scanner. All images were obtained by using a 3-mm reconstruction with 1.5-mm collimation. Scanning times were 0.5 seconds per rotation. These 3-dimensional images were reconstructed by using an independent imaging workstation. In complex cases, reconstructed images are very useful in consultation with treating physicians. |
 | Media file 34: Thoracic spine trauma. Scout view image from a spiral CT scan shows a complete subluxation fracture (curved blue lines) of the lower thoracic spine. Such an injury combines lateral displacement with rotational injury (arrow). |
 | Media file 35: Thoracic spine trauma. Fracture dislocation of the lower thoracic spine. Axial CT image demonstrates the large distance that the lower thoracic spine has been displaced. |
 | Media file 36: Thoracic spine trauma. Sagittal T2-weighted MRI of the thoracolumbar junction demonstrates a complete dislocation at the T12-L1 interspace (arrow). |
 | Media file 37: Thoracic spine trauma. Three-dimensional volume image of the thoracic and lumbar spine demonstrates a fracture dislocation of the T11-T12 vertebrae. |
 | Media file 38: Thoracic spine trauma. Epidural air (black arrow) is noted, as is gas in the muscular layers of the neck (white arrows). |
 | Media file 39: Thoracic spine trauma. Axial CT myelogram in a patient with a gunshot wound to the thoracic spine. While a fracture is obvious, the injury also resulted in a dural tear with a freely leaking cerebrospinal fluid space (white arrow). The midline fracture of the vertebral body is noted in the lower image (black arrow). |
 | Media file 40: Thoracic spine trauma. Axial CT image demonstrates a complex fracture of the T12 with rotation subluxation. Air was introduced into the epidural space during the injury. |
 | Media file 41: Thoracic spine trauma. Sagittal multiplanar CT image of a burst fracture following fixation. The image has been cut in the sagittal plane. Surgical repair of unstable thoracic spine fractures, such as this burst fracture, usually involves placement of an interposition graft (double black arrow) together with a lateral plate held in position by screws placed into the vertebral body above and below the injury. A residual fragment of the burst fracture is seen anteriorly (white arrow). The double white arrow illustrates the restored spinal canal. |
 | Media file 42: Thoracic spine trauma. Shaded-surface 3-dimensional CT image of a burst fracture following fixation. The image has been cut in the sagittal plane. Surgical repair of unstable thoracic spine fractures, such as this burst fracture, usually involves placement of an interposition graft (double black arrow) together with a lateral plate held in position by screws placed into the vertebral body above and below the injury. A residual fragment of the burst fracture is seen anteriorly (white arrow). |
 | Media file 43: Thoracic spine trauma. Shaded-surface 3-dimensional CT image of a gunshot wound to the thoracic spine. Although the bullet passed into the interspace, causing a fracture of the vertebral body, the bullet stopped within the spinal canal. Note the outline drawn around the bullet (arrow). |
 | Media file 44: Thoracic spine trauma. Shaded-surface 3-dimensional CT scan of a gunshot wound to the thoracic spine. In other cases, the bullet may enter the spinal canal superior to the final position in the canal. The passage of the bullet within the spinal canal (yellow arrow) destroys the spinal cord and also may result in a fracture of the vertebral body. Note that the bullet has been darkened (blue arrow). |
 | Media file 45: Thoracic spine trauma. Axial CT image in a man with known pulmonary tuberculosis and back pain. Note the left-sided paraspinal abscess (arrow). |
 | Media file 46: Thoracic spine trauma. Sagittal shaded-surface 3-dimensional reconstruction CT scan of the lower thoracic spine. The spinal image has been cut in the midsagittal plane to demonstrate posterior displacement of the thoracic spinal vertebral body (arrow) and downward displacement of the superior endplate. Note the general wedge shape of the vertebral body. |
 | Media file 47: Thoracic spine trauma. Coronal shaded-surface display of the compression fracture shown in Image 39. Note the downward displacement of the vertebral body endplate (double blue arrow) and the small central cold abscess (black arrow). |
 | Media file 48: Thoracic spine trauma. Microscopic image of a smear from a paravertebral abscess aspirate (same patient as in Images 39-40). Note the red stain associated with tuberculosis. Tuberculosis is one of the more common causes of spinal compression fracture in the underdeveloped nations of Asia and the Far East (acid-fast stain, magnification X100). |
More on Thoracic Spine, Trauma |
| Overview: Thoracic Spine, Trauma |
| Imaging: Thoracic Spine, Trauma |
| Follow-up: Thoracic Spine, Trauma |
 Multimedia: Thoracic Spine, Trauma |
| References |
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References
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Further Reading
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Keywords
Chance fracture, spinal compression fracture, burst fracture, thoracic trauma, thoracic fracture, spinal fractures, seatbelt injury, thoracic fracture-dislocation, Denis classification, Denis fractures
