The Thoracolumbar Spine  

Fracture prevalence | Projections | Stability | Classification of trauma | Pathology

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Fracture prevalence

Assess on both images:

  • Height of vertebral bodies should be equal.
  • Width of intervertebral disc spaces should be uniform.
  • Continuity of superior and inferior endplates: should remain unbroken.
  • Distance between spinous process should be equal.
  • Trace the posterior elements; the pedicles, laminae, and spinous processes.

    normal lumbar spine   normal lumbar spine

Specifically on the AP image:

  • Soft tissue signs – Widening of the paraspinal line adjacent to the left side of the thoracic spine is indicative of a haematoma resulting from a fracture:

paraspinal haematoma T4/5 dislocation

  • Pleural cap – Refers to a paraspinous haematoma, which dissects over lung apex.
  • Inter-pedicular distance. Should become gradually wider from L1 to L5.
  • Check for an “empty” vertebral body on the AP film; the posterior elements should be superimposed.
  • Transverse processes should remain intact.

Specifically on the lateral image:

  • Malalignment. Trace the anterior, posterior and spinolaminar lines. If two of these lines are disrupted, the injury is considered unstable.
  • Posterior vertebral body cortex should be slightly concave.
Significance of Injury and the concept of stability
Classification of acute trauma
Nose =
Transverse process
Eye =
Ear =
Superior facet
Front leg =
Inferior facet
Collar through neck =

   fracture pars interarticularis   fracture pars interarticularis

self test


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