Case 9. Case 9. Imaging studies, 1 month after a fall. This patient had fracture in the L1 vertebral body with avascular necrosis. There was also fracture.

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Presentation transcript:

Case 9. Case 9. Imaging studies, 1 month after a fall. This patient had fracture in the L1 vertebral body with avascular necrosis. There was also fracture in the anterior inferior T12 vertebral body. The fracture line extended posteriorly with the involvement of the superior articular process of L1, the inferior articular process, and spinous process of T12. All 3 columns were involved.A, Conventional radiograph, showing ossification of the ALL, and reduced height with wedge deformity of the L1 vertebral body (arrows) and fracture in the facet (arrowhead).B, T1-weighted image, showing a hypointense signal intensity in the L1 vertebral body (white arrow) due to avascular necrosis and edema, fracture of the T12 spinous process (black arrow), and soft tissue disruption and ligament tears in the posterior column (white arrowhead).C, T2-weighted image, showing avascular necrosis with fluid inside the L1 vertebral body (white arrow), edema posterior to the fluid cavity, as well as retropulsion with stenosis of the spinal canal and compression of the cord. The bone fracture, ligament tears in the posterior column, and adjacent soft tissue disruption are hypointense (arrowhead).D, Gadolinium-enhanced T1-weighted image, showing the nonenhancing components of avascular necrosis and edema inside the L1 vertebral body (arrow) with enhancement beyond its border. The fracture in the posterior component is delineated with marginal enhancement (black arrowhead). There is enhancement in the anterior inferior T12 vertebral body (white arrowheads) caused by an occult fracture. The fracture cannot be surely identified in the conventional radiograph (A). It became obvious in the conventional radiograph of the spine taken later (not shown). Yi-Fen Wang et al. AJNR Am J Neuroradiol 2005;26:2067-2076 ©2005 by American Society of Neuroradiology