1. Local percussion pain Pain aggravated on motion and weight-bearing position Injury history, substantial or trivial Neurologic deficits Spine Fractures

2. Orientation September, 2008 脊椎外科. 李晏瑤

3. Compression fracture Burst fracture with neurologic deficits Spine Fractures The spine can be considered as a three-column structure Denis classification of thoracolumbar trauma. (A) Compression fracture. (B) Burst fracture. (C) Flexion--distraction injury. (D) Lateral and posterior view of a fracture-dislocation.

4. The Supine Cross-Table Lateral Radiograph Can Efficiently Detect Intravertebral Cleft in Vertebral Compression Fracture?

5. Background Some osteoporotic vertebral compression fractures (VCFs) are mobile. Intravertebral clefts (IV clefts) identified in every mobile fracture and absent from every nonmobile fracture. Fergus McKiernan, et al. The dynamic mobility of vertebral compression fractures, Journal of Bone and Mineral Research, 2003;18(1): 24-29.

6. Background Supine cross-table lateral radiographs determine the dynamic mobility of VCFs Fergus McKiernan, et al. The dynamic mobility of vertebral compression fractures, Journal of Bone and Mineral Research, 2003;18(1): 24-29. * A pillow

7. 3 patients with painful VCFs Plain Radiographs Supine cross-table lateral radiographs  2 patients underwent percutaneous vertebroplasty (PV)

8. Case 1, T12 * * *

9. Pain relief !

10. Case 2, L3 * * (Arrhythmia with pacemaker used) Pain persisted !

11. Case 3, L1 * *

12. Summery

13. Discussions IV clefts were detected by * conventional lateral xrays: 8.8% * extension stress xrays: 33.3% * supine cross-table xrays: 82.4% MRIs: ?% (taken in supine position) Hiroyuki Hashidate, et al. Pseudoarthrosis of vertebral fracture: radiographic and characteristic clinical features and natural history. Orthopaedic Science. 2006, 11: 28-33

14. Fluid-filled clefts were detected on preop. MRIs in 52.8% of the fractures with opacified clefts after cement augmentation. Gas-filled clefts were evident on preop. conventional xrays in only 11.4% of opacified clefts after cement augmentation Supine cross-table xrays? John I. Lane, et al. Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implication, and prognostic significance. ANJR 2002, 23: 1642-46

15. Preop. supine cross-table xrays Vs. MRIs (supine):  Supine cross-table xrays can detect gross mobility with/without IV cleft (superior to MRIs?)  MRIs (T2W or Gadollium enhanced T1W) can detect nonhealed VCFs (“micromotion”)

16. if supine cross-table xrays detecting mobility superior to MRIs Conclusions – if supine cross-table xrays detecting mobility superior to MRIs Painful VCFs with local tender Plain xrays + supine cross-table xrays Mobile PV Non-mobile (Fixed) MRIs (T2W/Gadollium enhanced T1W) Hyperintensity PV Normal intensity PV

17. Thank you for your attention