J Korean Soc Radiol.  2016 Sep;75(3):185-190. 10.3348/jksr.2016.75.3.185.

CT Findings Predictive of Neurological Deficits in Thoracolumbar Burst Fractures

Affiliations
  • 1Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea. tymn@pusan.ac.kr
  • 2Department of Radiology, Pusan National University Hospital, Busan, Korea.

Abstract

PURPOSE
To determine the computed tomography (CT) findings predictive of neurological deficits in thoracolumbar spine injuries.
MATERIALS AND METHODS
One hundred two patients with thoracolumbar spinal burst fractures, after excluding the patients with brain and cervical cord injuries and unconsciousness, who underwent consecutive spine 128-multidetector CT scan formed the study group. The neurological findings were clinically classified as no deficit (n = 58), complete deficit with paraplegia (n = 22), and incomplete deficit with either motor or sensory impairment (n = 22). The following four CT imaging parameters were analyzed: the level of the main burst fracture as the cord (n = 44) and the cauda equina (n = 58) levels; the extent of canal encroachment as central canal ratios (CCRs) below 0.5 (n = 43) and above 0.5 (n = 59); the degree of laminar fracture as no fracture (n = 33), linear fracture (n = 7), separated fracture (n = 27), and displaced fracture (n = 35); fractured vertebra counted as single (n = 53) and multiple (n = 49).
RESULTS
Complete neurological deficit was associated with injuries at the cord level (p = 0.000) and displaced laminar fractures (p = 0.000); incomplete neurological deficit was associated with CCRs below 0.5 (p = 0.000) and multiple vertebral injuries (p = 0.002).
CONCLUSION
CT scan can provide additional findings predictive of neurological deficits in thoracolumbar spinal burst fractures.


MeSH Terms

Brain
Cauda Equina
Cervical Cord
Humans
Lumbar Vertebrae
Nervous System Diseases
Paraplegia
Spinal Injuries
Spine
Thoracic Vertebrae
Tomography, X-Ray Computed
Unconsciousness

Figure

  • Fig. 1 The value of the central canal ratio is the narrowest diameter of the canal (b) divided by the normal anteroposterior diameter (a) on the axial CT scan.

  • Fig. 2 The grades of laminar fractures. A. A 23-year-old woman with an incomplete neurological deficit. The axial CT scan shows a grade 1 linear laminar fracture of the 2nd lumbar vertebra (arrow). B. A 48-year-old man with a complete neurological deficit. The axial CT scan shows a grade 2 separated laminar fracture of the 8th thoracic vertebra (arrow). C. A 45-year-old woman with a complete neurological deficit. The axial CT scan shows a grade 3 displaced laminar fracture of the 11th thoracic vertebra (arrow).

  • Fig. 3 A 52-year-old male with an incomplete neurological deficit in multiple vertebral injuries. A. The sagittal CT scan demonstrates one burst fracture of the 1st lumbar vertebra (thick black arrow) and three compression fractures of the 2nd to the 4th lumbar vertebrae (thin black arrows). B. The sagittal MR T2 image illustrates one burst fracture of the 1st lumbar vertebra (thick white arrow) and three compression fractures of the 2nd to the 4th lumbar vertebrae (thin white arrows).


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