Keywords:
Emergency, Musculoskeletal spine, Trauma, CT, MR, Technical aspects, Imaging sequences, Acute, Oedema
Authors:
R. Rajakulasingam1, N. Bhatt2, S. Choudhary2; 1Birmingham/UK, 2University hospital, Birmingham/UK
DOI:
10.26044/ecr2019/C-2669
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 1mm slice thickness (bone algorithm B70s Siemens).
Image analysis was performed on a standard PACS workstation (Agfa Impax),
by two Radiology Registrars and 1 Consultant Musculoskeletal Radiologist; findings were recorded in consensus.
Loss of vertebral body height was identified stating the level and ratio of height compared to level above and below.
Presence or absence of a ‘cortical step sign’,
fracture line (lucent,
sclerotic,
mixed or not visible),
comminution and burst morphology were assessed.
Presence of degenerative disc disease,
facet OA,
schmorl’s nodules and spondylolisthesis was recorded.
On the basis of CT morphology,
the presence or absence of an acute vertebral compression fracture was recorded.
MRI of the spine,
if performed for the study group,
was collated and evaluated separate to the CT in a blinded fashion,
the observer for MRI unaware of the CT findings.
Eventually the CT and MRI findings were merged for analysis.
When MRI was not performed,
clinical findings and further follow up imaging were used as gold standard to assess if the fracture was treated as acute.
Statistical tests were applied to assess if the presence of a cortical step as an isolated radiological sign on CT scans,
can predict an acute compression fracture of the TL spine.