eMedicine Specialties > Radiology > Musculoskeletal
Lumbar Spine, Trauma: Multimedia
Updated: Apr 12, 2007
Multimedia
 | Media file 1: Lumbar spine trauma. Drawing of the thoracolumbar spine viewed from an oblique frontal projection. AF indicates annulus fibrosis; DNR, dorsal nerve root; NP, nucleus pulposus; NRG, nerve root ganglion; SC, spinal cord; SN, spinal nerve; TP, transverse process; VB, vertebral body; and VNR, ventral nerve root. |
 | Media file 2: Lumbar spine trauma. The normal lumbar spine consists of 5 vertebral bodies that are fully articulated and without associated ribs. The anterior lumbar vertebral bodies are slightly greater in vertical height than the posterior body, which results in a natural lordotic curve of the lower back.The last thoracic vertebral body (T12) has a rib facet. The first sacral segment (S1) is usually not fully articulated. The sacral joint (SJ) lies lateral to the sacrum. |
 | Media file 3: Lumbar spine trauma. Lateral drawing of a lumbar vertebral body. The vertebral bodies of the lumbar spine are larger and thicker than those of the thoracic spine. The facet joints of the lumbar spine are oriented in a more anterior-posterior plane than those of the thoracic spine. |
 | Media file 4: Lumbar spine trauma. Drawing of 2 lumbar segments viewed from an oblique angle. The outline of the facets and the pars interarticularis have the appearance of the "neck" of a Scottie dog. |
 | Media file 5: Lumbar spine trauma. The structures of the lumbar spine can be considered as 3 columns. Trauma to the lumbar spine may result in injury limited to the anterior, middle, or posterior column, or it may involve multiple spinal columns, resulting in gross instability. |
 | Media file 6: Lumbar spine trauma. Lateral drawing of the 3 spinal columns of the thoracolumbar junction. The anterior column (black dotted line) includes the anterior spinal ligament, the anterior annulus fibrosis, the intervertebral disc, 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 (thick blue dotted line) includes all of the spine posterior to the longitudinal ligament (thick blue dotted line). |
 | Media file 7: Lumbar spine trauma. Imaging methods that may be useful in the evaluation of the patient with an acutely injured lumbar spine. |
 | Media file 8: Lumbar spine trauma. Lateral radiograph demonstrates an L3 spinal compression fracture. Note the downward compression of the superior endplate of the L3 (yellow arrow). The anterior portion of the L3 vertebral body has been displaced forward (white arrow). |
 | Media file 9: Lumbar spine trauma. Lateral radiograph of an L2 fracture demonstrates a pattern of downward compression (yellow arrow) and anterior fracture fragment displacement (white arrow). |
 | Media file 10: Lumbar spine trauma. A 35-year-old man presented to the emergency department after a motor vehicle accident. He complained of back pain without paresthesias or weakness of his lower extremities. Axial CT image demonstrates a compression fracture of the upper lumbar spine. Note the comminuted fracture pattern. |
 | Media file 11: Lumbar spine trauma. A 35-year-old man presented to the emergency department after a motor vehicle accident. He complained of back pain without paresthesias or weakness of his lower extremities. Sagittal reformatted CT image demonstrates fracture of the anterior L1 vertebral body with a posterior fragment displaced into the spinal canal (black arrow). The fracture extended into the spinous process (yellow arrow). A second fracture in the L3 vertebral body is noted in the posterior aspect of the inferior endplate of the L3 (white arrow). |
 | Media file 12: Lumbar spine trauma. Sagittal multiplanar reformatted CT scan demonstrates a compression fracture of the L1 vertebral body (white arrow). A large fragment of bone projects into the spinal canal (yellow arrow). |
 | Media file 13: Lumbar spine trauma. A Chance fracture or a modified compression fracture of the upper lumbar spine may occur when the weight of the upper body moves forward (red arrow) while the person's waist and upper body are fixed in position by the seatbelt or steering wheel of an automobile (pink arrows). The resulting fixed-position stress results in a fracture. |
 | Media file 14: Lumbar spine trauma. Anterior view of a Chance fracture of the L2 vertebral body. The fracture line follows a horizontal plane through the L2 vertebral body and the transverse processes (arrows). |
 | Media file 15: Lumbar spine trauma. Drawing of a Chance fracture of the thoracolumbar 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 16: Sagittal T2-weighted MRI of an L2 compression fracture. Relatively little deformity of the L2 vertebral body is shown, with less than 5° of kyphotic forward angulation. Compression fractures with little angulation often are associated with significant posterior ligamentous trauma (arrow). |
 | Media file 17: Lumbar spine trauma. Sagittal T2-weighted gradient-echo MRI demonstrates a compression fracture of the L1 vertebral body with a small bony fragment displaced into the spinal canal. |
 | Media file 18: Lumbar spine trauma. Lateral radiograph demonstrates postoperative results after stabilization of an L1 compression fracture. |
 | Media file 19: Lumbar spine trauma. Drawing of the primary force involved in compression burst injury of the lumbar spine. The vertical force is directed into the central portion of the lumbar endplate (arrow). The force results in both downward and axial displacement of fragments of the vertebral body endplate. |
 | Media file 20: Lumbar spine trauma. Drawing of the mechanism of injury of the lumbar spine burst injury is compared with an axial CT image. The centrally applied vertical force results in radial expansion of the vertebral body endplate. The posterior margin of the endplate may be displaced into the spinal canal (arrow). |
 | Media file 21: Lumbar spine trauma. Axial CT image in a patient with compression burst fracture of the lumbar spine. The posterior margin of the compression burst fracture is displaced into the spinal canal (black arrows). The anterior margin of the vertebral body is fractured, with a pattern of compression (white arrows), while a transverse fracture extends from the anterior to the lateral margin of the vertebral endplate (yellow arrow). |
 | Media file 22: Lumbar spine trauma. Sagittal view of a multiplanar reformatted image of the lumbar spine. Spinal compression fractures are identified at the L2 and L5 levels. The vertical forces (arrows) have resulted in posterior displacement of a bone fragment into the spinal canal at the L2 vertebral body. As a result of a single traumatic event, compression fractures of the L2 and L5 have occurred. |
 | Media file 23: Lumbar spine trauma. Coronal view of a multiplanar reformatted image of the lumbar spine. Spinal compression fractures are identified at the L2 and L5 levels. The vertical forces (yellow arrows) have resulted in posterior displacement of a bone fragment into the spinal canal at the L2 vertebral body. As a result of a single traumatic event, compression fractures of the L2 and L5 have occurred. The coronal multiplanar reformatted image demonstrates more completely the vertical nature of the fracture patterns of the L2 and L5 (yellow arrows). |
 | Media file 24: Lumbar spine trauma. Axial T1-weighted MRI in a patient with lumbar spine compression burst injury. A comminuted fracture of the lumbar spine endplate (arrow) results in spinal canal narrowing. |
 | Media file 25: Lumbar spine trauma. Axial CT (right) and axial MRI (left) images of an upper lumbar spine burst injury. While the CT image presents better detail concerning the bone injury, the MRI image fully illustrates the position of the conus. |
 | Media file 26: Lumbar spine trauma. Axial T2-weighted MRI image in a patient with a burst fracture injury to the upper lumbar spine. The posterior margin of the vertebral endplate has been displaced into the spinal canal (arrow). Cerebrospinal fluid is seen as bright signal anterior to the conus and upper cauda equina. |
 | Media file 27: Lumbar spine trauma. A 35-year-old man presented to the emergency department after a motor vehicle accident. He complained of back pain without paresthesias or weakness of his lower extremities. Findings on the sagittal T2-weighted MRI confirms edema in the posterior L1 vertebral body (white arrow), while stenosis is noted posterior and inferior to the L1 (yellow arrow). |
 | Media file 28: Lumbar spine trauma. Sagittal T1-weighted MRI of the lumbar spine demonstrates a severe degree of compression of the L1 vertebral body (arrow). More than 60% of the vertical height of the L1 has been lost due to a compression failure of the L1 body. |
 | Media file 29: Lumbar spine trauma. Two contiguous sagittal T2-weighted MRIs of the lumbar spine demonstrate a compression fracture of the L1 vertebral body. The anterior aspect of the L1 is compressed more than 60%. The posterior margin of the fracture encroaches into the spinal canal at the L1 level. |
 | Media file 30: Lumbar spine trauma. Sagittal reformatted CT image in a patient with lumbar vertebral body distraction (arrow). Distraction injury commonly is associated with injury to the conus of the distal spinal cord. |
 | Media file 31: Lumbar spine trauma. Three-dimensional reconstruction of a CT scan of the thoracic and lumbar spine in a patient with complex injury. The L1 vertebral body is compressed with a severe rotation of the L1 vertebral body under the T12. This injury was associated with a severe neurologic injury to the conus and cauda equina. |
 | Media file 32: Lumbar spine trauma. Sagittal T1-weighted MRI of the lumbar spine. A 40-year-old man without any preceding event presented with sudden severe low back pain after lifting at work. He underwent chiropractic manipulation without relief of pain. The pain radiated into his right thigh. Lumbar spine findings were abnormal, and additional studies were performed. |
 | Media file 33: Lumbar spine trauma. Axial T1-weighted MRI of the lumbar spine in a 40-year-old man without any preceding event who presented with sudden severe low back pain after lifting at work. The patient underwent chiropractic manipulation without relief of pain. The pain radiated into his right thigh. Lumbar spine findings were abnormal, and additional studies were performed. The results confirm narrowing of the right side of the spinal canal (arrow) due to pathologic fracture. |
 | Media file 34: Lumbar spine trauma. Axial CT images of an L2 compression burst fracture after posterior fusion with pedicle screws (yellow arrow) joined by a posterior bar (white arrow). The pedicle screws should be entirely within the bone of the body and pedicle of the vertebral bodies. |
 | Media file 35: Lumbar spine trauma. Axial CT image after a lumbar myelogram. Contrast material is noted in the posterior paraspinal region outside of the thecal sac (yellow arrows). The pedicle screws were noted to follow a satisfactory course within the pedicles of the L4 and L5 vertebral bodies. The dural leak was later successfully repaired. SC indicates the spinal canal. |
 | Media file 36: Lumbar spine trauma. Oblique view of 3-dimensional reconstruction of a multisection CT scan of the lumbar spine after posterior fusion of an L2 burst fracture. Note the fractures of the L2 vertebral body and the anterior endplate of the L4 body (white arrows). Pedicle screws have been placed in the L1, L2, and L3 (yellow arrows) vertebral bodies. By using multisection CT scanning, artifacts related to the pedicle screws are kept to a minimum. |
 | Media file 37: Lumbar spine trauma. Sagittal 3-dimensional surface model of a CT scan of the lumbar spine after transpedicular fixation of the L4-5 interspace. Although the pedicle screws are in a satisfactory position within the pedicles of L4 and L5, a leak is present in the dura. Contrast material from an intrathecal injection has collected in the extradural space (arrows). Dural repair was later successful. |
 | Media file 38: Lumbar spine trauma. Sagittal 3-dimensional and multiplanar reformatted CT images of a fixation of the thoracic-lumbar junction. A bone graft and fixation plate have been positioned across the T11-T12-L1 levels. |
 | Media file 39: Lumbar spine trauma. Lateral view of the lumbar spine demonstrates a compression fracture (arrow). Because the patient's pain was of recent onset, the fracture was considered to be acute. The loss of vertebral body height is less than 50%. The patient was considered to be a good candidate for treatment with vertebroplasty. |
 | Media file 40: Lumbar spine trauma. True lateral views of the lumbar spine during the performance of a vertebroplasty procedure. A, The needle is introduced through the pedicle into the area of compression within the vertebral body. B, The bone cement agent, mixed with radiopaque barium, is injected into the compression fracture. C, After successful injection of the cement, the needle is removed. Note that the bone cement now supports the superior aspect of the compression fracture (double arrow). |
More on Lumbar Spine, Trauma |
| Overview: Lumbar Spine, Trauma |
| Imaging: Lumbar Spine, Trauma |
| Follow-up: Lumbar Spine, Trauma |
 Multimedia: Lumbar Spine, Trauma |
| References |
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References
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Further Reading
Keywords
Chance fracture, pathologic fracture, burst fracture, insufficiency fracture, spondylolysis deformity, spondylolisthesis, lumbar spine trauma, lumbar spine injury, lumbar spine fracture
