Fracture, Vertebral Body



Fracture, Vertebral Body


Julia Crim, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Vertebral Body Only



    • Anterior Compression Fracture, Thoracic


    • Anterior Compression Fracture, Lumbar


    • Lateral Compression Fracture, Lumbar


    • Lateral Compression Fracture, Thoracic


    • Burst Fracture (Mild)


    • Pathologic Vertebral Fracture


    • Hyperflexion Injury, Cervical


    • Hyperextension Injury, Cervical


  • Vertebral Body Plus Posterior Elements



    • Burst Thoracolumbar Fracture


    • Burst Fracture, Lumbar


    • Burst Fracture, Cervical


    • Pathologic Vertebral Fracture


    • Burst Fracture, C2


    • Hyperflexion Injury, Cervical


    • Hyperextension Injury, Cervical


    • Chance Fracture, Thoracic


    • Distraction Fx, Low Thoracic


  • Fracture Mimics



    • Schmorl Node


    • Limbus Vertebra


    • Kyphosis, Idiopathic


    • Scheuermann Disease


    • Sickle Cell


    • Scoliosis and Kyphosis, Congenital


    • Neurogenic (Charcot) Arthropathy


    • Osteomyelitis, Pyogenic


Less Common



  • Lymphoma


  • Cushing Disease


  • Kümmell Disease


  • Osteomyelitis, Granulomatous


  • Congenital Syndromes



    • Failure of Vertebral Formation


    • Osteogenesis Imperfecta


    • Diastematomyelia


    • Achondroplasia, Mucopolysaccharidoses


    • Mucopolysaccharidoses


Rare but Important



  • Ewing Sarcoma


  • Apophyseal Ring Fracture


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Mechanism of injury



    • Compression, burst: Axial load injuries


    • Chance: Anterior compression, posterior distraction


    • Fracture/dislocation: Shear forces


  • Treatment of different types of fractures is different, so imaging distinction is important


  • Imaging may overestimate or underestimate mechanical instability of spine


  • Fracture vs. fracture mimic



    • History of trauma may not be available or reliable


    • Fractures may be single or multiple levels


    • May have different kinds of fractures at different levels



      • e.g., burst and compression at 2 different levels


    • Multiple, uniformly involved levels of deformity usually not traumatic


Helpful Clues for Common Diagnoses



  • Compression Fracture



    • Does not involve posterior vertebral body cortex or posterior elements


    • Common throughout thoracic and lumbar spine


    • May involve anterior or lateral portion of vertebral body


    • Often occur at multiple levels in normal or osteoporotic bone


    • Most common type of pathologic fracture


  • Burst Fracture



    • Burst fracture extends through posterior cortex of vertebral body


    • More severe burst fractures show vertically oriented fractures of neural arch


    • Most common at thoracolumbar junction


  • Chance Fracture



    • Anterior compression vertebral body


    • In conjunction with horizontally oriented fracture of posterior elements OR ligamentous injury resulting in separation of adjacent spinous processes


    • Most common at thoracolumbar junction


  • Hybrid Fractures



    • Some fractures have elements of both burst- and chance-type injury



      • Retropulsion of posterior vertebral body cortex + separation of posterior elements


      • Best to categorize as Chance and add description of burst elements


  • Compression or Burst Fracture due to Trauma or Osteoporosis




    • MR: Band-like configuration of abnormal signal


    • CT: Trabeculae compressed but not destroyed


  • Compression or Burst Fracture due to Tumor



    • Radiographic findings



      • Focal osteopenia or osteosclerosis


      • Cortical destruction


      • Nonvisualization of pedicle contour on AP radiograph a helpful sign


    • MR findings



      • Rounded configuration of abnormal signal, or diffuse abnormal signal adjacent to fracture


      • Cortical breakthrough beyond fracture line is often seen


      • Additional areas of abnormal signal without fracture helpful signs when present


    • CT findings



      • Destruction of trabeculae adjacent to fracture


      • Cortical break beyond fracture line is often seen


      • Additional areas of bony destruction without fracture helpful signs when present


  • Limbus Vertebra



    • Ossicle anterior corner of vertebral body, smoothly contoured & corticated


    • Failure of fusion of ring apophysis


  • Kyphosis, Idiopathic



    • Smooth vertebral endplate contour, multiple vertebrae


    • Diagnosis of exclusion


  • Scheuermann Disease



    • Undulating contour of endplates


    • Discrete Schmorl nodes variably present


    • 4 or more contiguous vertebral bodies with at least 5° wedging each


  • Sickle Cell



    • H-shaped or “Lincoln Log” vertebrae with central depression and preserved margins


  • Infection or Neuropathic Arthropathy

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Fracture, Vertebral Body

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