Lumbar Bony Trauma
Julia Crim, MD
DIFFERENTIAL DIAGNOSIS
Common
Fractures
Anterior Compression Fracture
Burst Fracture
Chance Fracture
Pathologic Vertebral Fracture
Facet-Posterior Fracture
Transverse Process Fracture
Fracture Mimics, Vertebral Body
Schmorl Node
Physiologic Wedging
Limbus Vertebra
Scheuermann Disease
Scoliosis and Kyphosis, Congenital
Neurogenic (Charcot) Arthropathy
Sickle Cell
Osteomyelitis, Pyogenic
Post-Operative Spinal Complications
Fracture Mimics, Posterior Elements
Incomplete Fusion, Posterior Element
Spondylolysis
Post-Operative Change, Normal
Less Common
Fracture and Post-Traumatic Abnormalities
Lateral Compression Fracture
Fracture-Dislocation
Kümmell Disease
Insufficiency Fracture, Pedicle
Apophyseal Ring Fracture
Fracture Mimics
Renal Osteodystrophy
Achondroplasia
Osteomyelitis, Granulomatous
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
Anterior Compression Fracture
Never involves posterior vertebral body cortex or neural arch
Unless osteoporosis, > 40% loss of height suggests Chance fracture, not compression
Burst Fracture
Extends through posterior vertebral body cortex
Usually but not always have retropulsion of fragment into spinal canal
Fractures of posterior elements vertically oriented
Chance Fracture
Often extends through posterior cortex
Always either horizontally oriented posterior element fracture OR widened interspinous distance due to interspinous ligament rupture
Transverse Process Fracture
Associated with retroperitoneal soft tissue injury, bony and ligamentous injury in pelvis
Physiologic Wedging
May be seen at T11-L1 levels
Usually affects both superior and inferior endplates equally
No angular deformity of endplates or anterior cortexRelated posts:
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