Medical Imaging/Radiology Lumbar Spine Fractures Assessment Answer

fracture are the critical back pain, osteoporosis, loss of height etc. These lumbar vertebrae provide support, stability allowing the functionality of human body that includes proper walking; movement and upright stand basically the normal lumbar curve. Hence, the occurrence of fracture in lumbar spine alters the lumbering shape leading to reduction or extension in lumbar curve of the body. Secondly, fracture leads to severe pain in this region that can be unresolvable. Further, ignorance of pain can lead to thoracic kyphosis involving hip pain, spinal joints pain, and sacroiliac pain. Therefore, these situations increase the secondary fracture risk.

The most common category of lumbar spine fracture are compression fracture occurring due to transverse, axial loading persisting increased chances of neurological injuries in compression fractures (3,4).

The direct trauma on posterior spine due to flexion and rotation can give rise to spinous fractures. However, these spinous fractures do not cause neurological effects but maximise the chances of transverse fractures as well as they can cause retroperitoneal space bleeding that can cause ileus or acute anaemia. Further, spondylolisthesis is another medical consequence of lumbar spine fracture that can occur even after the recovery of fracture. The slip is present at the time of injury but can occur months or years later in life that leads to disk degeneration (5).

Details about the Imaging Procedures Employed to Evaluate the Pathology

There are different imaging procedures employed for imaging different categories of lumbar spine fractures where the most commonly applicable technique is Standard lateral, oblique and AP radiographs. The defects in height and shape of vertebrae are easily detectable through radiographic techniques. However, in plain radiography, there can be falsely positive or negative indications due to secondary ossification, previous kyphosis and superimposed bowel gas (false-positive) whereas spondylolisthesis gives the false negative indication. Further, the bone density measurement technique is applied to detect osteoporosis (3,6).

For getting high-resolution imaging and clear detection of fracture the thin-section axial CT scanning process is used in lumbar spine fracture detection process. This technique is suitable for blunt traumatic conditions that are not detectable through plain radiograph. The other imaging procedures employed are Magnetic resonance imaging, ultrasonography, and nuclear imaging process. The MRI is helpful for generating multiple projections imaging whereas ultrasonography helps to detect upper lumbar and chest wall injuries. Further, nuclear imaging is used to differentiate failure of epiphyseal endplate from fractures (2,3,7).

Discussing the Radiologic Features

The different types of lumbar spine fracture highlight different radiologic features in radiography where compression of superior L3 endplate indicates spinal compression fracture. The downward compression of L2 and fragment displacement determines anterior fracture in lateral radiography. Further, AP radiographs there are interpedicular distances between L1 to L5 that indicate fractures. There are swelling in soft tissue in AP view assures fracture even if the fracture is not directly visible.

The major radiologic features of compression fracture are vertebra fall from height and the major radiologic features of burst fracture are angulation of thoracolumbar junction, canal narrowing and neurologic injury. Further, the oblique radiographs highlight the Scottie dog configuration where neck defect is dog shaped configuration that indicates spondylolysis. These were some of the most common radiologic features of lumbar spine fractures (2,3).

Discussing the Treatment Options

The treatment options for lumbar spine fractures depends on the fracture patterns

Flexion Fracture Pattern

The non-surgical treatment for fractures (burst and osteoporotic) due to flexion fracture includes physical activities and rehabilitation exercises. Bracing for 6-12 weeks is used to treat these fractures. However, the spine surgery is recommended in case of vertebral height loss, excessive bending or angulation, multiple bone fragments and nerve injuries.

Extension Fracture Pattern

The non-surgical treatment involves wearing cast or brace for 12 weeks, these fracture patterns generally won’t need a surgery whereas in severe cases like disk falls and injury on posterior ligaments leads to spine surgery

Rotation Fracture Pattern

The non-surgical treatment involves motion increase exercises without brace or cast whereas surgery is needed in case of severe nerve damage or serious spinal cord injury.

Comprehensive Fracture Pattern

Back brace and bone heals are suitable for treatment of mild injuries whereas vertebroplasty and kyphoplasty are used as the surgical process to induce cement into fractured bone (8,9,10).

References

Fractures of the Thoracic and Lumbar Spine-OrthoInfo – AAOS. Orthoinfo.aaos.org. 2016 [cited 27 August 2016]. Available from: https://orthoinfo.aaos.org/topic.cfm?topic=a00368

Lumbar Spine Fractures and Dislocations: Background, Anatomy, Pathophysiology. Emedicine.medscape.com. 2016 [cited 27 August 2016]. Available from: https://emedicine.medscape.com/article/1264191-overview#a9

The Radiology Assistant : Spine - Thoracolumbar injury. Radiologyassistant.nl. 2016 [cited 27 August 2016]. Available from: https://www.radiologyassistant.nl/en/p4906c8352d8d2/spine-thoracolumbar-injury.html

Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, Pranzl R, Gercek E, Schultheiss M, Weckbach A, Bühren V. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. European Spine Journal. 2010 Oct 1;19(10):1657-76.

McPhee SJ, Papadakis MA, Tierney LM, editors. Current medical diagnosis & treatment 2010. New York:: McGraw-Hill Medical; 2010 Nov 5.

Rantakokko J, Frantzén JP, Heinänen J, Kajander S, Kotilainen E, Gullichsen E, Lindfors NC. Posterolateral Spondylodesis Using Bioactive Glass S53P4 and Autogenous Bone in Instrumented Unstable Lumbar Spine Burst Fractures; a Prospective 10-Year Follow-Up Study. Scandinavian Journal of Surgery. 2012 Mar 1;101(1):66-71.

De Iure F, Cappuccio M, Paderni S, Bosco G, Amendola L. Minimal invasive percutaneous fixation of thoracic and lumbar spine fractures. Minimally invasive surgery. 2012 Jul 16;2012.

Lehman RA, Paik H, Eckel TT, Helgeson MD, Cooper PB, Bellabarba C. Low lumbar burst fractures: a unique fracture mechanism sustained in our current overseas conflicts. The Spine Journal. 2012 Sep 30;12(9):784-90.

Khalatbari MR, Khalatbari I, Moharamzad Y. Intracranial hemorrhage following lumbar spine surgery. European Spine Journal. 2012 Oct 1;21(10):2091-6.

Meredith DS, Kepler CK, Huang RC, Brause BD, Boachie-Adjei O. Postoperative infections of the lumbar spine: presentation and management. International orthopaedics. 2012 Feb 1;36(2):439-44.