Semin Musculoskelet Radiol 2014; 18(03): 240-245
DOI: 10.1055/s-0034-1375567
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Traumatized Vertebral Spine Reloaded: Injury Mechanisms and their Radiologic Patterns

Gerd Schueller
1   Department of Radiology, Spital Bülach, Bülach, Switzerland
,
Claudia Schueller-Weidekamm
2   Section Head of Functional and Morphological Musculoskeletal Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging und Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
04 June 2014 (online)

Abstract

The ideal classification of spinal trauma does not yet exist, primarily because the implementation of morphological, biomechanical, and clinical parameters in a single nomenclature is a difficult task. For radiologists and surgeons, who are partners in trauma teams, only a few classifications of injury patterns have been shown to be useful enough to provide rapid and stable therapy decisions in daily practice. From a didactic point of view, however, simplifications of injury mechanisms are of help to become aware of the most important radiologic injury patterns of vertebral trauma. The members of trauma teams should be aware of the strengths and limitations of existing descriptions of imaging features when reporting trauma to the spine. These are discussed in this article.

 
  • References

  • 1 Schueller G. Who is who revisited: spinal trauma [in German]. Radiologe 2010; 50 (12) 1084-1095
  • 2 Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994; 3 (4) 184-201
  • 3 Reinhold M, Blauth M, Rosiek R, Knop C. Lower cervical spine trauma: classification and operative treatment [in German]. Unfallchirurg 2006; 109 (6) 471-480 ; quiz 481–483
  • 4 Kim CW, Perry A, Garfin SR. Spinal instability: the orthopedic approach. Semin Musculoskelet Radiol 2005; 9 (1) 77-87
  • 5 Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8 (8) 817-831
  • 6 Willén J, Anderson J, Toomoka K, Singer K. The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord 1990; 3 (1) 39-46
  • 7 Daffner RH, Deeb ZL, Rothfus WE. “Fingerprints” of vertebral trauma—a unifying concept based on mechanisms. Skeletal Radiol 1986; 15 (7) 518-525
  • 8 Chance GQ. Note on a type of flexion fracture of the spine. Br J Radiol 1948; 21 (249) 452
  • 9 Han SY, Witten DM, Mussleman JP. Jefferson fracture of the atlas. Report of six cases. J Neurosurg 1976; 44 (3) 368-371
  • 10 Gehweiler JA, Duff DE, Martinez S, Miller MD, Clark WM. Fractures of the atlas vertebra. Skeletal Radiol 1976; 1: 97-102
  • 11 Langner S, Fleck S, Kirsch M, Petrik M, Hosten N. Whole-body CT trauma imaging with adapted and optimized CT angiography of the craniocervical vessels: do we need an extra screening examination?. AJNR Am J Neuroradiol 2008; 29 (10) 1902-1907
  • 12 Malhotra AK, Camacho M, Ivatury RR , et al. Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. Ann Surg 2007; 246 (4) 632-642 ; discussion 642–643
  • 13 Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br 1981; 63-B (3) 319-327
  • 14 Samaha C, Lazennec JY, Laporte C, Saillant G. Hangman's fracture: the relationship between asymmetry and instability. J Bone Joint Surg Br 2000; 82 (7) 1046-1052
  • 15 Palmieri F, Cassar-Pullicino VN, Dell'Atti C , et al. Uncovertebral joint injury in cervical facet dislocation: the headphones sign. Eur Radiol 2006; 16 (6) 1312-1315
  • 16 O'Callaghan JP, Ullrich CG, Yuan HA, Kieffer SA. CT of facet distraction in flexion injuries of the thoracolumbar spine: the “naked” facet. AJR Am J Roentgenol 1980; 134 (3) 563-568
  • 17 Daffner SD, Daffner RH. Computed tomography diagnosis of facet dislocations: the “hamburger bun” and “reverse hamburger bun” signs. J Emerg Med 2002; 23 (4) 387-394
  • 18 Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI ; National Emergency X-Radiography Utilization Study Group. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2000; 343 (2) 94-99
  • 19 Stiell IG, Wells GA, Vandemheen KL , et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001; 286 (15) 1841-1848
  • 20 Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma 2005; 58 (5) 902-905
  • 21 Anglen J, Metzler M, Bunn P, Griffiths H. Flexion and extension views are not cost-effective in a cervical spine clearance protocol for obtunded trauma patients. J Trauma 2002; 52 (1) 54-59
  • 22 Oman JA, Cooper RJ, Holmes JF , et al; NEXUS II Investigators. Performance of a decision rule to predict need for computed tomography among children with blunt head trauma. Pediatrics 2006; 117: e238-e246
  • 23 Hsu JM, Joseph T, Ellis AM. Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury 2003; 34 (6) 426-433
  • 24 Schüller-Weidekamm C. Cervical spine injury. . Diagnosis, prognosis and management [in German]. Radiologe 2008; 48 (5) 480-487
  • 25 Pang D, Wilberger Jr JE. Spinal cord injury without radiographic abnormalities in children. J Neurosurg 1982; 57 (1) 114-129
  • 26 Hendey GW, Wolfson AB, Mower WR, Hoffman JR ; National Emergency X-Radiography Utilization Study Group. Spinal cord injury without radiographic abnormality: results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma. J Trauma 2002; 53 (1) 1-4
  • 27 Maynard Jr FM, Bracken MB, Creasey G , et al; American Spinal Injury Association. International Standards for Neurological and Functional Classification of Spinal Cord Injury. Spinal Cord 1997; 35 (5) 266-274
  • 28 Bondurant FJ, Cotler HB, Kulkarni MV, McArdle CB, Harris Jr JH. Acute spinal cord injury. A study using physical examination and magnetic resonance imaging. Spine 1990; 15 (3) 161-168