Fracture, Posterior Element



Fracture, Posterior Element


Julia Crim, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Cervical



    • Hyperextension Injury, Cervical


    • Burst Fracture, Cervical


    • Hangman’s C2 Fracture


    • Lateral Flexion Injury, Cervical


    • Jefferson C1 Fracture


    • Burst Fracture, C2


    • Clay Shoveler’s Fracture


    • Hyperflexion-Rotation Injury, Cervical


    • Hyperflexion Injury, Cervical


  • Thoracic



    • Chance Fracture, Thoracic


    • Burst Thoracolumbar Fracture


    • Facet-Lamina Fracture, Thoracic


  • Lumbar



    • Burst Fracture, Lumbar


    • Spondylolysis


    • Facet-Posterior Fracture, Lumbar


    • Transverse Process Fracture


    • Chance Fracture, Lumbar


    • Pedicle Stress Fracture


  • All Spinal Levels



    • Pathologic Vertebral Fracture


Less Common



  • Fracture Mimics



    • Metastases, Lytic Osseous


    • Incomplete Fusion, Posterior Element


    • Neurogenic (Charcot) Arthropathy


    • Vertebral Segmentation Failure


    • Hypoplastic Rib, Supernumerary Rib


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Must distinguish between isolated posterior column injury and multicolumn injury



    • Isolated posterior column



      • Due to lateral flexion or rotation, direct blow, or hyperflexion


      • Clay shoveler’s fracture a stable hyperflexion injury


    • Multiple column



      • Due to any injury mechanism, not necessarily unstable


      • Non-bony involvement of middle, anterior columns often best seen on MR


Helpful Clues for Common Diagnoses



  • Prevertebral soft tissues of cervical spine may be normal in isolated posterior element fracture


  • Burst fracture: Posterior column fracture in vertical plane


  • Flexion-distraction fracture: Posterior column fracture in horizontal plane


  • Spondylolysis easily missed on axial images; use following signs



    • “Double facet” sign: Spondylolysis is anterior to facet joint


    • “Wide canal” sign: Increased AP dimension of spinal canal






Image Gallery









Axial bone CT shows bilateral C2 pedicle fractures image indicating hangman’s-type fracture.

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Fracture, Posterior Element

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