0:01

I want to make the distinction between the

0:03

chance fracture which is sometimes called the

0:06

seatbelt fracture from the burst fracture, and these

0:09

usually occur at the thoracolumbar junction.

0:13

Remember that the chance fracture is a fracture

0:15

which also involves the posterior elements.

0:18

In this case,

0:18

we see it crossing the pedicle as well as the

0:21

facet and going into the spinous process.

0:24

Here we have one that's going from the vertebral

0:27

body into the facet, but not into the spinous process.

0:32

And here you have the rip that's demonstrated within

0:35

the disc but also crossing into the facet joint

0:40

and from there essentially into the lamina.

0:43

Here on our axial scan,

0:45

we see the involvement of the posterior vertebral body

0:48

as well as the lamina on the right side

0:52

and the pedicle is also disrupted.

0:54

Here you have a fracture which involves the

0:58

superior facet very similar to this fracture.

1:01

And you can see that going across on

1:03

the coronal reconstruction. Finally,

1:06

we have one that's a little bit more dramatic with the

1:09

vertebral body from anterior to posterior involvement and

1:14

then going into the pedicle, and then separating the

1:17

superior and inferior portions of the facet joint

1:20

on the one side. These are chance fractures.

1:24

Here we have another example, anterior vertebral body,

1:27

posterior vertebral body.

1:29

We're looking for any involvement of the

1:31

transverse process or the posterior elements.

1:35

In this particular case,

1:37

although there was involvement

1:38

of the vertebral bodies,

1:39

it really wasn't involving the posterior elements.

1:42

But what we do see is probably the most common

1:45

of the fractures in the lumbar spine,

1:47

which is the transverse process avulsion fracture.

1:51

The transverse processes are attached to the psoas

1:54

musculature, and in motor vehicle injuries,

1:57

it's not uncommon for us to see bilateral

2:00

evolution of the transverse process.

2:03

The transverse process fractures themselves are

2:06

usually not treated surgically because

2:09

they are stable injuries. However,

2:11

because you may see a concomitant fracture

2:14

involving the vertebral body in this case going

2:16

from anterior into the posterior body.

2:19

Anterior and posterior body.

2:21

This may be surgically corrected or the patient

2:24

may be put in long term splinting.

2:26

Another example of a transverse process fracture

2:29

at the junction with the vertebral body.

2:32

Here's one.

2:33

Just a small avulsion of the most peripheral

2:35

portion of the transverse process.

2:39

Let's talk about the difference between a

2:41

compression fracture versus a burst fracture.

2:46

With the compression fracture,

2:47

what we may see is just superior or inferior endplate

2:51

depression. It may go from anterior to posterior.

2:55

Doesn't really go through the central aspect

2:57

of the vertebral body and spares the

3:00

posterior elements.

3:01

This is very common in osteoporotic individuals.

3:04

It may be seen also in the motor vehicle collisions as

3:08

one of the more common of the two fractures

3:11

that we see in the lumbar spine,

3:13

that being transverse process fracture

3:15

and compression fracture.

3:16

Contrast that with the burst fracture.

3:19

So the burst fracture has multiple fragments.

3:21

It has to include the posterior vertebral body

3:25

margin, and quite often it will compromise

3:29

the spinal canal.

3:30

Notice here that although you have

3:31

the compression deformity,

3:33

there's no compromise of the AP diameter of the spinal

3:35

canal as opposed to this comminuted burst fracture,

3:40

where pieces of the bone often will compromise

3:43

the spinal canal. Fortunately,

3:44

when it occurs in the lumbar spine,

3:46

you're below the spinal cord.

3:47

If this occurs in the thoracic spine, however,

3:51

you may be causing compression of the spinal

3:54

cord and the potential for paraparesis

3:57

in the lower extremities.

3:59

Here we have an example of a patient who has transverse

4:02

process fractures. But not only that,

4:05

when we look on the coronal image

4:07

of the vertebral body itself,

4:09

we have a comminuted fracture of the vertebral

4:12

body that was involving the posterior margin

4:16

as well, a so called burst fracture.