Best Practice Case Studies-Compression Fractures

Video Transcription

Hi, this is Sagar Wagle, one of the musculoskeletal radiology fellows at Stanford University.  We have a case of a 15 year old male with acute onset back pain during a football game.  Spine radiographs in general are insensitive for fractures,  especially in the upper thoracic spine region where there is a lot of overlap from the shoulder tissue. In these radiographs  we see that the vertebral bodies have normal height and alignment and we do not see any fractures.  Let's look at the MRI of the patient and focus on T5 and T6 vertebral body. There is edema signal in T5 and T6 vertebral bodies and  when we compare these vertebral bodies to the T4 vertebral body,  we can see that they have slight height loss. As you go from top to bottom in spine, the vertebral bodies should have similar or slightly increased size as we go below.  So this patient has compression fracture of T5 and T6 vertebral bodies.  I have another case of a 35 year old male in a car accident.  The vertebral bodies have roughly normal height and alignment and again, the upper thoracic vertebral bodies are not well seen due to overlap from the shoulder.  Let's look at the CT. As we scroll through the CT, we can see that there is fracture of the T5 vertebral body  anteriorly and there is also fracture of the posterior element of T5 and  as you go to this image, we can see that the T5 vertebral body has slight height loss when you compare it to T4 vertebral body and we can also see the spinous process fractures of  T5 and T4.  We can see the fracture on coronal image as well.  On the CT, we could only appreciate the T5 vertebral body fracture, but when we look on the MRI, we see edema signal of T3, T4, T5 and  T6 vertebral bodies. So this person has multiple vertebral body fractures.  We don't always do MRI in case of compression fractures. If there are concerning neurological symptoms  or if there is meaningful retropulsion of the fracture fragments into the spinal canal, MRI would be helpful.  The patient was treated with posterior rod and screw fixation of the thoracic spine.  Thank you for watching the video.

Video Summary

The video discusses two cases involving vertebral fractures. A 15-year-old male experiences back pain from a football game, with MRI showing compression fractures in T5 and T6 despite normal radiograph findings. A 35-year-old male is involved in a car accident; CT reveals a fracture in T5, and MRI shows additional fractures from T3 to T6. Radiographs often miss fractures due to shoulder overlap in the upper thoracic spine. MRI is used for detailed assessment, especially if neurological symptoms are present. The latter patient underwent surgical treatment with rod and screw fixation of the thoracic spine.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 53

Topic Spine

Keywords

3rd Edition, CASE 53

3rd Edition

Spine

vertebral fractures

thoracic spine

MRI assessment

compression fractures

surgical treatment