Aims and objectives
Differentiating an acute from chronic compression fracture of the thoraco-lumbar (TL) spine can pose a dilemma for radiologists interpreting spinal imaging following trauma.
Mild wedging of the vertebrae can be due to spondylosis or osteoporosis,
whilst acute simple compression fractures may not always be associated with loss of body height.
Confirmation of a vertebral body wedge on CT with MRI,
could delay patient management in polytrauma.
We hypothesize that the presence of a vertebral body cortical step on CT scan is an accurate and reliable...
Methods and materials
In this retrospective study,
the radiology database (CRIS) was searched for all patients who had a CT scan of the thoracic and or lumbar spine from 2016-2018 at a major trauma centre,
for a suspected fracture of the TL spine following trauma.
Patients with previous spinal surgery and known malignancy were excluded.
Patient demographics such as age,
sex,
mechanism of injury and details of other injuries were recorded.
Reformats of the TL spine on CT scans were reviewed in sagittal,
coronal and axial planes at...
Results
184 consecutive CT scans from 2016-2018 were included in our study.
The basic demographics of our study cohort detailing age and mechanism of injury are stated in (Fig 5)
131/184 patients (71%) had a cortical step. 125 were reported as acute compression fractures on CT (true positives),
6 had a step but were reported as chronic compression fractures (false positive) these were reviewed to represent severe osteoporotic wedge fractures/Kummel's disease,
confirmed as chronic clinically.
44 of the 125 patients had a subsequent MRI which confirmed...
Conclusion
Our results demonstrate a high sensitivity and specificity of a ‘cortical step sign’ in diagnosis of an acute vertebral body compression fracture of the TL spine on CT scans.
We propose that radiologists actively look for this sign to help in diagnosing an acute vertebral body compression fracture.
Accurate assessment will allow for safe radiological clearance of the TL spine in trauma CT.
A false positive cortical step can be found in Kummel’s disease and severe chronic osteoporotic compression fractures with fragmentation.
In such cases,...
Personal information
Correspondence details:
Dr Ramanan Rajakulasingam,
Queen Elizabeth hospital,
University Hospital Birmingham NHS Trust
[email protected]
Author information:
Dr Naman Bhatt
(Queen Elizabeth hospital,
University Hospital Birmingham NHS Trust)
Dr Surabhi Choudhary
(Queen Elizabeth hospital,
University Hospital Birmingham NHS Trust)
Acknowledgement toDr Rajesh Botchu
(Royal Orthopaedic hospital NHS foundation trust,
Birmingham,
Uk)
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