BROOKLYN 3STUDENTS

Sophie PERYMAN

Fri 30th Aug 2013Session 2 / Talk 3

10:55 – 11:05

ABSTRACTTraumatic spinal fractures are not particularly commonplace in emergency departments. However, due to the risks of debilitation it is essential for patients to be accurately imaged and diagnosed in order for the most appropriate treatment plan to put in place. This paper will specifically discuss burst fractures: mechanism of injury, clinical signs, imaging options (historical and current thinking) and prognosis. Burst fractures account for 17% of all spinal fractures and due to their nature, are often associated with compromise of the spinal canal to some degree. With the rapid technological advances in imaging modalities, the options for imaging burst fractures have evolved. In order to ensure best practice, consideration should be given to choosing the most appropriate technologies instead of being tempted to use all of the modalities. This paper will explore the current multimodality approaches to imaging burst fractures in order to demonstrate the essential role of the MIT in optimizing the patient pathway.

BURST FRACTURES

A Multimodality imaging approach

Sophie PerymanBachelor of Health Science (Medical Imaging)Unitec

OVERVIEW

• Definition

• Mechanisms of injury

• Classification systems

• Imaging pathways

• Summary

ASIANIA AIRLINES CRASH

http://i2.cdn.turner.com/cnn/dam/assets/130706190825-san-francisco-plane-crash-18b-horizontal-gallery.jpg

ASIANIA AIRLINES CRASH

http://www.nydailynews.com/news/national/asiana-flight-214-pilots-realized-seconds-crash-approach-slow-article-1.1392535

ASIANIA AIRLINES CRASH

http://cdn-wac.emirates247.com/polopoly_fs/1.513667.1373338995!/image/3595643928.jpg

BURST FRACTURE DEFINED• Failure of anterior

and middle margins

• Potential for neurological damage

• Typical mechanisms of injury

MECHANISMS OF INJURY

INTERVERTEBRAL DISKS

INTERVERTEBRAL DISKS

3-COLUMN CLASSIFICATION SYSTEM

Denis (1983)

• Anterior column• Middle column• Posterior column

Middle column considered to be of paramount importance to spinal stability

THORACOLUMBAR INJURY CLASSIFICATION & SEVERITY SCORE (TLICS)

Vaccaro (2005)

Based on three important injury characteristics:1. Morphology of injury 2. Integrity of posterior ligamentous complex3. Neurological status of the patient

CHOICE OF IMAGING MODALITY

Cassar-Pullicino & Tins (2006) claim the biggest problem of imaging spinal injury patients is the choice of the appropriate imaging modality in

the different stages of patient care.

CHOICE OF IMAGING MODALITY: XRAY

1. Severe compression of vertebral body

2. Disruption of posterior body line

3. Widening of interpedicle distance

http://radiopaedia.org/articles/burst-fracture

Abitol et al. (1992)

CHOICE OF IMAGING MODALITY: XRAY

http://radiopaedia.org/articles/burst-fracture

CHOICE OF IMAGING MODALITY: CT

http://radiopaedia.org/articles/burst-fracture

CHOICE OF IMAGING MODALITY: CT

http://www.sciencephoto.com/image/426178/350wm/F0039177-Degenerative_disc_disease,_3D_CT_scan-SPL.jpg

CHOICE OF IMAGING MODALITY: MRI

http://images.radiopaedia.org/images/11026/5c06fbb2b629222ff83a9518915302.jpg

SUMMARY

REFERENCES

• Abitbol, J., Ballock, R., Cervilla, V., Garfin, S., Mackersie, R., & Resnick, D. (1992). Can burst fractures be predicted from plain radiographs? The Bone & Joint Journal, 74, (1), 147 – 150. Retrieved from http://www.bjj.boneandjoint.org.uk/content/74-B/1/147.full.pdf+html

• Anderson, M., Kulstad, C., & Tuite, A. (2008). Thoracolumbar spine and pelvis plain radiography. In J. C. Fox (Ed.), Clinical Emergency Radiology (pp. 106 – 116). New York City: Cambridge University Press.

• Cowan, J & Rommey, L.. (2013). SF plane crash: injured suffer spinal injuries, internal bleeding. Retrieved from http://www.latimes.com/local/lanow/la-me-ln-san-francisco-plane-crash-injured-suffer-spinal-injuries-internal-bleeding-20130706,0,2189046.story

• Daffner, R., Deeb., & Rothfus, W. (1987). The posterior vertebral body line: importance in the detection of burst fractures. Americal Journal of Roentgenology, 148 (1), 93 – 96. Retrieved from http://www.ajronline.org/doi/abs/10.2214/ajr.148.1.93

• Daffner, R. H., & Daffner, S. D. (2006). Vertebral Injuries: Detection and Implications. In V. N. Cassar-Pullicino & H. Imhof, Spinal Trauma – An Imaging Approach (pp. 36 – 54). New York City: Theime.

• Fox, J. C., & Habicht, M. E. R. (2008). CT of the spine. In J. C. Fox (Ed.), Clinical Emergency Radiology (pp. 404 – 419). New York City: Cambridge University Press.

• Fox, J. C., & Harries, A. (2008). MRI of the spine. In J. C. Fox (Ed.), Clinical Emergency Radiology (pp. 538 – 559). New York City: Cambridge University Press.

• Government of Western Australia. (2013). Diagnostic Imaging Pathways – Thoraco-Lumbar Spine Injury. Retrieved from http://www.imagingpathways.health.wa.gov.au/index.php/imaging-pathways/musculoskeletal-trauma/bone-and-joint-trauma/thoraco-lumbar-spine-trauma#pathway

• Mayfield Clinic. (2013). Anatomy of the Spine. Retrieved from http://www.mayfieldclinic.com/PE-AnatSpine.htm#.UhR47xZH2_t• OrthopedicsOne. (2012). Thorcolumbar burst fracture. Retrieved from http://www.orthopaedicsone.com/display/Main/Thoracolumbar+burst+fracture• The USC Centre for Spinal Surgery. (2013). Thoracolumbar Spine Fractures. Retrieved from http://www.uscspine.com/conditions/spine-fractures.cfm • Tins, B., & Cassar-Pullicino, V. N. (2006). Optimizing Imaging Options. In V. N. Cassar-Pullicino & H. Imhof, Spinal Trauma – An Imaging Approach (pp. 36 – 54). New York

City: Theime.• Rajasekaran, S. (2009). Thoracolumbar burst fractures without neurological deficit: the role for conservative treatment. Eur Spine J, 19 (1), 40 – 47. doi:

10.1007/s00586-009-1122-6• Zbeblick, T. (2012). Burst Fractures: defined and diagnosed. Retrieved from http://www.spineuniverse.com/conditions/spinal-fractures/burst-fractures-defined-

diagnosed

Thank you for your attention!