Thoracic and lumbar spine trauma

The frequency and distribution of fractures of the thoracic and lumbar spine are reviewed. Classifications of thoracolumbar spine injuries are considered. Compression or wedge fractures, burst fractures, lap seat-belt-type injuries, and fracture-dislocations are considered with discussion of findings on conventional radiography and computed tomography. The concepts of stability and instability are briefly discussed and the relative advantages of computed tomographic imaging are reviewed.     

Thoracic trauma with injuries of the thoracic spine

From a major series of surgically treated patients with fractures and fracture dislocations of the thoracic spine 4 cases are presented exhibiting different trauma mechanisms and presenting with a variety of associated acute and chronic intrathoracic lesions. Surgical stabilisation and treatment of additional intrathoracic injury (vascular, lymphatic duct, empyema, posttraumatic fibrothorax) necessitated a transpleural approach, effective for the spine as well. Diagnostic radiology was restricted to minimal requirements due to urgency and/or difficulties of exposure.     

Thoracic spine: percutaneous trephine biopsy

Forty-one percutaneous trephine biopsies of thoracic vertebral bodies or disks from T-3 to T-12 were performed under fluoroscopic guidance without complications. Biopsy technique was improved by a new set of trephine needles using a procedure similar to vascular catheterization and specific prone-oblique positioning of the patient. On a 35 degrees prone-oblique view, the heads (dorsal extremities) of the ribs determine the direction of puncture. Both pleura and spinal canal are easily recognized and avoided. Of 40 cases, there were 31 true-positive results, six contributory results, and three false-negative results. Percutaneous biopsy of the thoracic spine with this technique is a safe, rapid, and reliable procedure.     

Thoracic spine CT, diagnostic efficacy

In 67 patients the diagnostic efficacy of thoracic spine CT was assessed. Diagnoses suspected clinically or by other examination methods could be confirmed by CT in 81% and excluded in 18% of cases. In one per cent (one case) the diagnosis, myelopathia vascularis, could not be seen by CT nor by myelography. In 49 cases the results of thoracic spine CT and myelography were compared with each other. CT gave additional information to myelography in 27% (13/49), but not in 73% (36/49). In 27% (18/67) of the whole material CT was able to replace myelography. It seems that CT is useless if myelography is normal, but CT may be useful in tumors, infections and medullary diseases. In traumas CT may replace myelography.     

Thoracic angiography and intervention in trauma

Interventional radiologists are involved less often in the initial diagnostic evaluation of patients who have acute chest trauma today than in the past. Patients are cleared of significant injury by CT, or, when a significant injury is present, they are triaged appropriately to open surgery or endovascular intervention. Significant advances in catheter-based technology, such as stent grafts and embolization coils, allow definitive repair of thoracic aortic and branch vessel injury. The opportunity to treat these types of injury with minimally invasive techniques has reinforced a continuing need for the maintenance and continued development of skills in the performance and interpretation of thoracic angiography. This article reviews these techniques and examines the status and the future of endovascular interventions in thoracic trauma.     

Computed tomography of spine trauma

Nine patients admitted to the hospital for spine trauma were studied with computed tomography. The use of computed tomography minimized patient motion, allowed excellent definition of compromise of the spinal canal by fracture fragments, and better delineated fractures of the neural arches than plain films or tomography. Plain radiographs and computed tomography scans permitted complete evaluation of spine trauma with no additional investigations being necessary.     

MR imaging in cervical spine trauma

Continual improvements in MR imaging, technology and MR imaging-compatible monitoring and fixation devices have allowed the incorporation of this relatively new imaging modality into standard algorithms for cervical spine trauma assessment. The ability of MR imaging to define the type of spinal cord injury, the cause and severity of spinal cord compression, and the stability of the spinal column is unmatched. The heavy reliance of the spinal surgeon on MR imaging for decisions regarding the type of therapy, the timing, the approach of surgical intervention, and for predicting patient outcome attests to the usefulness of this modality.     

Cervical spine evaluation in pediatric trauma

OBJECTIVE: This article will review the current literature as it relates to imaging of the child suspected to have cervical spine injury (CSI) and the imaging findings of pediatric CSI, focusing on strategies to minimize radiation dose while maximizing diagnostic yield. CONCLUSION: Although CSI is uncommon in children, the clinical implications of failure to correctly diagnose CSI are significant. Clinical decision rules proven effective in predicting CSI in adults cannot be uniformly applied to children.     

Thoracic spine disc-related abnormalities: longitudinal MR imaging assessment

Objective To describe and characterize the temporal changes in disc-related disorders of the thoracic spine using MR imaging.Design and patients A retrospective longitudinal cohort study was carried out of 40 patients with two sequential thoracic spine MR images at variable intervals. The images were assessed for baseline presence of, new incidence of and changes in disc herniation, degenerative disc disease, endplate marrow signal alteration and Schmorl nodes.Results The range of follow-up was 4–149 weeks. Baseline presence was: disc herniation, 10% (49/480); degenerative disc disease, 14% (66/480); endplate marrow signal alteration, 2.3% (11/480); Schmorl nodes 9.6% (46/480). Most pre-existing lesions tended to remain unchanged. Herniations showed the most change, tending to improve in 27%. New incidence was: disc herniation, 1.5% (7/480), degenerative disc disease, 2% (10/480); endplate marrow signal alteration, 1.6% (8/480); Schmorl nodes, 2.1% (10/480). Disc degeneration was first visible at an 11-week interval and once established almost never changed over many weeks to months. Endplate signal alterations (Modic changes) were uncommon. Schmorl nodes show no change from baseline for up to 2 1/2 years. All findings predominated in the lower intervertebral levels from T6 to T10.Conclusion The most prevalent thoracic spine disc-related findings are degeneration and herniation. Disc herniations predominate in the lower segments and are a dynamic phenomenon. Disc degeneration can be rapidly evolving but tends to remain unchanged after occurrence. Endplate marrow signal changes were an uncommon manifestation of thoracic disc disease. Schmorl nodes showed the least change over time.     

Thoracic and lumbar spine fusion: postoperative radiologic evaluation

A retrospective review of 206 consecutive thoracic and lumbar fusions revealed a variety of surgical procedures performed for instability and malalignment after severe trauma. Stabilization procedures included insertion of 103 Harrington distraction and 15 Harrington compression rods, 84 Weiss spings, six Luque rods, and 10 miscellaneous plates and wires as single or multiple devices in combination with anterior and/or posterior fusions. Complications of surgical fusion included nine unhooked rods, six fatigue fractures of rods and springs, five overdistractions of vertebrae, four cases of severe kyphosis, and two failures of reduction. A meaningful postoperative radiologic evaluation can be accomplished only when indications for surgical techniques, their radiologic appearance, and possible complications are known.     

CT in the evaluation of spine trauma

Fifteen patients admitted for spine trauma in an 8 month period were studied with computed tomography (CT). All the patients had initial routine plain film screening, and 10 of 15 were also examined with conventional tomography. Five patients sustained vertical fall, axial-load injuries in the thoracolumbar junction region; two others suffered missile injury to the spine. CT provided more information than plain films in all these patients due to its superior imaging of bony detail and its ability to assess soft-tissue damage. In four of these patients, conventional tomography was done but contributed no additional information. Eight other patients sustained complex fractures of the cervical spine. In all but one, the combination of plain films and CT allowed complete evaluation of the injury. In one patient, conventional tomography showed an additional linear fracture one vertebral level below the main region of injury. Plain films and CT allow complete, safe, rapid, easily interpretable evaluation of spine trauma patients in the acute setting. Conventional tomography yields no additional clinically vital information in the acute evaluation of spine trauma, when plain films are abnormal. Its current ability to show finer bony detail than CT can be reserved for evaluating equivocal plain film and CT findings or more complete evaluation (if indicated) after the patient is clinically stable.     

Twelve significant signs of cervical spine trauma

Drawing on experience with over 400 cases of significant cervical spine trauma, we have noted 12 helpful roentgen signs that may serve to direct the physician's attention to such serious underlying changes as fractures and dislocations. These 12 anatomic alterations may provide both direct and indirect evidence of traumatic lesions which are not clearly identified on the initial radiographs. The changes fally into three principal groups: abnormal soft tissues, abnormal vertebral alignment, and abnormal articulations. Rarely do these signs occur in isolation; rather, several useful changes are usually present on the routine cervical spine series. Considering the recent marked increase in requests for skull and cervical spine films, as well as litigation arising from such studies, an appreciation of clues to occult traumatic alterations is mandatory for the practising radiologist and clinician.     

MR imaging in acute cervical spine trauma

Fourteen patients with cervical spine injuries, 12 with resultant neurological deficits, were scanned with magnetic resonance (MR) imaging within 7 days following injury. Useful information concerning the status of the spinal canal and disks was obtained in most cases. In addition, MR was able to suggest the nature of the pathological changes within the spinal cord, as well as hemorrhage and edema in the extraspinal soft tissues. These observations indicate that following acute cervical spine trauma, MR is a valuable technique in assessing injury to the spinal cord, surrounding soft tissues, vertebra, and disks.     

颈椎创伤患者手术的麻醉管理

目的探讨颈椎创伤患者的麻醉特点及管理。方法对本院2005年1月-2009年10月期间156例颈椎创伤患者的麻醉管理进行总结分析。结果所有患者均安全度过围术期,无死亡病例。采用手法固定下直视插管89例,可视喉镜辅助下插管36例,清醒下纤维支气管镜引导下气管插管31例,均插管成功。颈椎创伤患者术中循环稳定性较颈椎病手术患者差,有62例(39.74%)发生低血压,其中有53例(85.48%)使用了麻黄碱。53例(33.97%)发生了心动过缓,其中有50例(94.34%)使用了阿托品。全瘫患者的使用率最高,不全瘫患者使用率高于仅有感觉异常的患者。结论颈椎创伤患者颈部需要有效制动,循环稳定性差。合理管理颈椎创伤患者的气道,维持循环的稳定,积极保护神经功能,可以使患者安全度过围术期。