FIG. I FIG. 2-B

Copyright 1978 by 1/u- Journal of Bone and Jiii,ii Sur,i�-rv, Incorporaa-d

I 108 THE JOURNAL OF BONE AND JOINT SURGERY

Computed Tomography for a Bursting Fracture

of the Lumbar Spine

REPORT OF A CASE

BY P. W. NYKAMP, M.D.*, J, M. LEVY, M,D.*, F. CHRISTENSEN, M.D.*,

R. DUNN, M.D.*, AND J. HUBBARD, M.D.*, SCOTTSDALE, ARIZONA

From the Departtnents of Diagnostic Radiology, Neurosurgery, and Orthopedic Surger�’,

Scottsdale Memorial Hospital, Scottsdale

Computed tomography has been used to evaluate such metrizamide contrast medium in the subarachnoid space.

spinal lesions as those that compress the spinal cord or We recently used computed tomography to clearly reveal

nerve roots (spinal stenosis 6, spinal and paraspinal neo- how a so-called bursting fracture of the first lumbar yen-

Fig. I: A lateral roentgenogram of the fracture of the first lumbar vertebra does not show the posteriorly displaced fragment.Fig. 2-A: Computed tomography scan of the normal second lumbar vertebra of the same patient, for comparison.Fig. 2-B: A toniographic scan of the first lumbar vertebra shows the inverted-Y-shaped fracture with a fragment displaced into the spinal canal.

plasms�, dysraphism’, syringomyelia, neurofibroma, tebra produced a fragment compressing the cord at the

metatrophic dwarfism3, and henniation of a lumbar disc), level of the conus medullanis.

and the technique has been described with ‘ and without2

* Scottsdale Memorial Hospital. 7400 East Osborn Road, Case ReportScottsdale, Arizona 85251 . A twenty-two-year-old white woman fell six meters, landing on her

COMPUTED TOMOGRAPHY FOR A BURSTING FRACTURE OF THE LUMBAR SPINE 1 109

VOL. 60-A, NO. 8, DECEMBER 1978

feet and then falling on her buttocks. She was transferred to our institu-

tion from elsewhere because of severe pain in the back. Neural examina-

tion showed markedly decreased reflexes (patellar, ankle, and tibial) in

the lower extremities, and there was hyperesthesia in the area supplied

by the second sacral nerve. She had weak muscle tone in the anal sphinc-

ter. The muscles of both hips were weak and dorsiflexion of the right foot

was impossible. There was no loss of dorsiflexion of the left foot, and the

toes on the left moved downward on plantar stimulation. Roentgeno-

grams showed a compression fracture of the first lumbar vertebra with

only a questionable posterior displacement of a portion of the vertebral

body(Fig. 1).

Computed tomography showed an inverted-Y-shaped fracture with

a sharp, pointed fragment displaced seven millimeters toward the conus

medullaris (Figs. 2-A and 2-B).

The patient was treated with bed rest initially but surgical decom-

pression of the cord was done after four weeks when she failed to show

improvement neurally. After laminectomy for exposure, a bone fragment

from the third lumbar vertebra which was pressing on the conus was re-

moved. The patient improved markedly after the decompression.

Discussion

So-called bursting fractures are caused by vertical

compression of the vertebral column, forcing the end-plate

or nucleus of the disc into the vertebral body, which

“explodes”. Sometimes a fragment is displaced into the

neural canal, as in our patient. In this case we were able to

demonstrate, by computerized tomographic scanning, the

nature and position of the fracture in relation to the neural

canal. With the newer types of scanners, the nerve struc-

tures themselves often can be seen.

References

1. COIN, C. G.; CHAN, Y.-S.; KERANEN, VICTOR; and PENNINK, MENNO: Computer Assisted Myelography in Disc Disease. J. Computer AssistedTomog. , 1: 398-404, 1977.

2. GLENN, W. V.: New Multiplanar CT. Display Capabilities: Applications in the Spine. Presented at Symposium Ganzk#{246}rper-Computertomographie. Heidelberg, September 9 to October 1 , 1977.

3. HAMMERSCHLAG, S. B.; WOLPERT, S. M.; and CARTER, B. L.: Computed Tomography of the Spinal Canal. Radiology, 121: 361-367, 1976.4. JAMES, H. E., and OLIFF, MICHAEL: Computed Tomography in Spinal Dysraphism. J. Computer Assisted Tomog. , 1: 391-397, 1977.5. NAKAGAWA, HIR0SHI; HUANG, Y. P.; MALlS, L. I.; and WOLF, B. S.: Computed Tomography of Intraspinal and Paraspinal Neoplasms. J. Com-

puter Assisted Tomog. , 1: 377-390, 1977.6. TAVERAS, J. M., and WooD, E. H.: Diagnostic Neuroradiology. Ed. 2, vol. 2. Baltimore, Williams and Wilkins, 1976.

Copyright � 975 by The Jotictial o/ Bii,ii tutu Jiii,it .Siirgt-r�’. III(i,� ,,iil ted

Ewing’s Sarcoma: Unusual Presentation

Delineated by Computerized Tomography

REPORT OF A CASE

BY N. B. TUROFF, M.D.*, MELVIN BECKER, M.D.*, AND MICHAEL LEWIS, M.D.t,

NEW YORK, N.Y.

From the Departments of Orthopaedic Surgery and Radiology,

New York University - Bellevue Medical Center, New York City

Ewing’s sarcoma has long been regarded as one of the

most lethal primary bone tumors encountered by the or-

thopaedic surgeon. With the advent of modern

chemothenapeutic regimens coupled with a more refined

technique of radiotherapy, many more patients survive

than was the case in past decades. During the prolonged

period of survival, some metastatic manifestations of this

disease have been recognized, and in the case reported

here computerized tomognaphic scanning helped to show

their character.

a 30 Waterside Plaza, Apartment 7F, New York, N.Y. 10010.

t 215 East 68th Street, New York, N.Y. 10021.

Case Report

M. M. , a nine-year-old white boy, was admitted to our institution

on October 24, 1974, with pain in the distal part of the left femur. Roent-

genographic examination (Fig. 1) revealed a lesion of the femoral

diaphysis with mild demineralization in the marrow cavity and with ad-

jacent periosteal elevation. Open biopsy was performed and Ewing’s

sarcoma was diagnosed from the specimen so obtained.

There was no clinical or roentgenographic evidence of metastases.

The patient received radiotherapy in a dose of 4,500 rads to the femur

between October 3 1 , 1974, and September 9, 1975. He also received

chemotherapy, including actinomycin D and Cytoxan (cyclophos-

phamide). Treatment subsequently included Alkeran (melphalan) andAdriamycin (doxorubicin). The chemotherapy was terminated in August

1976. Roentgenograms made twenty-seven months after the initial diag-

nosis showed no apparent residual tumor (Fig. 2). Patchy areas of irregu-

lar mineralization in the distal part of the femur were noted and were as-