Medical Imaging/Radiology Lumbar Spine Fractures

Question: Discuss about theMedical Imaging/Radiology Lumbar Spine Fractures. Answer: Discussing the Condition/Pathological Process/Medical Significance The lumbar vertebrae are the very important parts of the spinal code that portions 5 strongest and largest vertebrae in the spine. Basically, these vertebrae are the section of lower back starting from thoracolumbar junction to sacrum. Any kind of vertebra collapse due to applied or extra force or traumatic condition is considered as lumber spine fracture. The forces leading to a fracture in this lumbar spine are compression, shear, rotation, extension, distraction and flexion (1,2). Further, (2) indicated that osteoporosis is also a leading cause of lumbar spine fracture that generally occurs in the postmenopausal situation. The most common category of lumbar spine fracture is compression fractures occurring due to vertebra weakening or trauma basically observed after osteoporosis. The major indications of lumbar fracture are the critical back pain, osteoporosis, loss of height etc. These lumbar vertebrae provide support, stability allowing the functionality of human body that includes proper walking; movement and upright stand basically the normal lumbar curve. Hence, the occurrence of fracture in lumbar spine alters the lumbering shape leading to reduction or extension in lumbar curve of the body. Secondly, fracture leads to severe pain in this region that can be unresolvable. Further, ignorance of pain can lead to thoracic kyphosis involving hip pain, spinal joints pain, and sacroiliac pain. Therefore, these situations increase the secondary fracture risk. The most common category of lumbar spine fracture are compression fracture occurring due to transverse, axial loading persisting increased chances of neurological injuries in compression fractures (3,4). The direct trauma on posterior spine due to flexion and rotation can give rise to spinous fractures. However, these spinous fractures do not cause neurological effects but maximise the chances of transverse fractures as well as they can cause retroperitoneal space bleeding that can cause ileus or acute anaemia. Further, spondylolisthesis is another medical consequence of lumbar spine fracture that can occur even after the recovery of fracture. The slip is present at the time of injury but can occur months or years later in life that leads to disk degeneration (5). Details about the Imaging Procedures Employed to Evaluate the Pathology There are different imaging procedures employed for imaging different categories of lumbar spine fractures where the most commonly applicable technique is Standard lateral, oblique and AP radiographs. The defects in height and shape of vertebrae are easily detectable through radiographic techniques. However, in plain radiography, there can be falsely positive or negative indications due to secondary ossification, previous kyphosis and superimposed bowel gas (false-positive) whereas spondylolisthesis gives the false negative indication. Further, the bone density measurement technique is applied to detect osteoporosis (3,6). For getting high-resolution imaging and clear detection of fracture the thin-section axial CT scanning process is used in lumbar spine fracture detection process. This technique is suitable for blunt traumatic conditions that are not detectable through plain radiograph. The other imaging procedures employed are Magnetic resonance imaging, ultrasonography, and nuclear imaging process. The MRI is helpful for generating multiple projections imaging whereas ultrasonography helps to detect upper lumbar and chest wall injuries. Further, nuclear imaging is used to differentiate failure of epiphyseal endplate from fractures (2,3,7). Discussing the Radiologic Features The different types of lumbar spine fracture highlight different radiologic features in radiography where compression of superior L3 endplate indicates spinal compression fracture. The downward compression of L2 and fragment displacement determines anterior fracture in lateral radiography. Further, AP radiographs there are interpedicular distances between L1 to L5 that indicate fractures. There are swelling in soft tissue in AP view assures fracture even if the fracture is not directly visible. The major radiologic features of compression fracture are vertebra fall from height and the major radiologic features of burst fracture are angulation of thoracolumbar junction, canal narrowing and neurologic injury. Further, the oblique radiographs highlight the Scottie dog configuration where neck defect is dog shaped configuration that indicates spondylolysis. These were some of the most common radiologic features of lumbar spine fractures (2,3). Discussing the Treatment Options The treatment options for lumbar spine fractures depends on the fracture patterns Flexion Fracture Pattern The non-surgical treatment for fractures (burst and osteoporotic) due to flexion fracture includes physical activities and rehabilitation exercises. Bracing for 6-12 weeks is used to treat these fractures. However, the spine surgery is recommended in case of vertebral height loss, excessive bending or angulation, multiple bone fragments and nerve injuries. Extension Fracture Pattern The non-surgical treatment involves wearing cast or brace for 12 weeks, these fracture patterns generally wont need a surgery whereas in severe cases like disk falls and injury on posterior ligaments leads to spine surgery Rotation Fracture Pattern The non-surgical treatment involves motion increase exercises without brace or cast whereas surgery is needed in case of severe nerve damage or serious spinal cord injury. Comprehensive Fracture Pattern Back brace and bone heals are suitable for treatment of mild injuries whereas vertebroplasty and kyphoplasty are used as the surgical process to induce cement into fractured bone (8,9,10). References Fractures of the Thoracic and Lumbar Spine-OrthoInfo AAOS. Orthoinfo.aaos.org. 2016 [cited 27 August 2016]. Available from: https://orthoinfo.aaos.org/topic.cfm?topic=a00368 Lumbar Spine Fractures and Dislocations: Background, Anatomy, Pathophysiology. Emedicine.medscape.com. 2016 [cited 27 August 2016]. Available from: https://emedicine.medscape.com/article/1264191-overview#a9 The Radiology Assistant : Spine - Thoracolumbar injury. Radiologyassistant.nl. 2016 [cited 27 August 2016]. Available from: https://www.radiologyassistant.nl/en/p4906c8352d8d2/spine-thoracolumbar-injury.html Reinhold M, Knop C, Beisse R, Audig L, Kandziora F, Pizanis A, Pranzl R, Gercek E, Schultheiss M, Weckbach A, Bhren V. 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