Presented by M.A. Kaeser, DC Spring 2009 Thoracic Spine Trauma Presented by M.A. Kaeser, DC Spring 2009

Compression Fractures M/C between T11 and T12 Combination of axial and flexion injury Compression fractures between the T4 and T8 segments occasionally occur in association with injuries related to convulsive seizures or electric shock therapy as a result of violent contractions of the thoracic and abdominal muscles Most are wedge shaped w/few having any neurological deficits

Paraspinal edema May be an indirect clue to the presence of a fracture http://download.imaging.consult.com/ic/images/S1933033207730938/ gr3-midi.jpg

Pathologic fractures Loss of posterior body height, pedicle and other structures and a paraspinal mass http://www.medscape.com/content/2003/00/46/53/465374/art-nf465374.fig3.jpg

MRI findings Abnormal marrow can be demonstrated Used to assess the involvement of the spinal cord http://www.biij.org/2007/4/e10/fig4.jpg

Fracture-Dislocation Occurs most often in the T4-T7 region Fractures of the lamina, facets or vertebral bodies are often associated with neurological damage or paralysis because the spinal canal is small and the blood supply is relatively sparse Unstable thoracic injuries may benefit from surgical stabilization

http://www.ajronline.org/cgi/content-nw/full/187/4/859/FIG12

MOI Severe MVAs Motorcycle accidents – rider is catapulted into stationary objects http://www.seeitornot.faketrix.com/content/thrash-pics/originals/bike-crash- motorcycle-accident-rider-loses-control.jpg

Radiographic Depiction Difficult and requires an overpenetrated frontal view Loss of vertebral body height Displacement Widened interpediculate distance Paraspinal widening Associated injuries: other fractures, aortic arch tears, sternal fractures, thoracic disc herniation, instability and rarely, Kummel’s disease

References Yokum TR, Rowe LJ. Essentials of Skeletal Radiology. Baltimore: Williams & Wilkins, 1996: 373–545.