Interactive Transcript
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I want to make the distinction between the
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chance fracture which is sometimes called the
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seatbelt fracture from the burst fracture, and these
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usually occur at the thoracolumbar junction.
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Remember that the chance fracture is a fracture
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which also involves the posterior elements.
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In this case,
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we see it crossing the pedicle as well as the
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facet and going into the spinous process.
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Here we have one that's going from the vertebral
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body into the facet, but not into the spinous process.
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And here you have the rip that's demonstrated within
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the disc but also crossing into the facet joint
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and from there essentially into the lamina.
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Here on our axial scan,
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we see the involvement of the posterior vertebral body
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as well as the lamina on the right side
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and the pedicle is also disrupted.
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Here you have a fracture which involves the
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superior facet very similar to this fracture.
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And you can see that going across on
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the coronal reconstruction. Finally,
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we have one that's a little bit more dramatic with the
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vertebral body from anterior to posterior involvement and
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then going into the pedicle, and then separating the
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superior and inferior portions of the facet joint
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on the one side. These are chance fractures.
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Here we have another example, anterior vertebral body,
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posterior vertebral body.
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We're looking for any involvement of the
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transverse process or the posterior elements.
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In this particular case,
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although there was involvement
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of the vertebral bodies,
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it really wasn't involving the posterior elements.
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But what we do see is probably the most common
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of the fractures in the lumbar spine,
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which is the transverse process avulsion fracture.
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The transverse processes are attached to the psoas
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musculature, and in motor vehicle injuries,
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it's not uncommon for us to see bilateral
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evolution of the transverse process.
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The transverse process fractures themselves are
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usually not treated surgically because
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they are stable injuries. However,
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because you may see a concomitant fracture
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involving the vertebral body in this case going
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from anterior into the posterior body.
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Anterior and posterior body.
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This may be surgically corrected or the patient
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may be put in long term splinting.
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Another example of a transverse process fracture
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at the junction with the vertebral body.
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Here's one.
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Just a small avulsion of the most peripheral
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portion of the transverse process.
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Let's talk about the difference between a
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compression fracture versus a burst fracture.
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With the compression fracture,
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what we may see is just superior or inferior endplate
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depression. It may go from anterior to posterior.
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Doesn't really go through the central aspect
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of the vertebral body and spares the
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posterior elements.
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This is very common in osteoporotic individuals.
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It may be seen also in the motor vehicle collisions as
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one of the more common of the two fractures
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that we see in the lumbar spine,
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that being transverse process fracture
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and compression fracture.
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Contrast that with the burst fracture.
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So the burst fracture has multiple fragments.
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It has to include the posterior vertebral body
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margin, and quite often it will compromise
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the spinal canal.
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Notice here that although you have
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the compression deformity,
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there's no compromise of the AP diameter of the spinal
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canal as opposed to this comminuted burst fracture,
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where pieces of the bone often will compromise
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the spinal canal. Fortunately,
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when it occurs in the lumbar spine,
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you're below the spinal cord.
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If this occurs in the thoracic spine, however,
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you may be causing compression of the spinal
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cord and the potential for paraparesis
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in the lower extremities.
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Here we have an example of a patient who has transverse
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process fractures. But not only that,
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when we look on the coronal image
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of the vertebral body itself,
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we have a comminuted fracture of the vertebral
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body that was involving the posterior margin
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as well, a so called burst fracture.
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