1. BROOKLYN 3 STUDENTS Sophie PERYMAN Fri 30 th Aug 2013 Session 2 / Talk 3 10:55 – 11:05 ABSTRACT Traumatic spinal fractures are not particularly commonplace in emergency departments. However, due to the risks of debilitation it is essential for patients to be accurately imaged and diagnosed in order for the most appropriate treatment plan to put in place. This paper will specifically discuss burst fractures: mechanism of injury, clinical signs, imaging options (historical and current thinking) and prognosis. Burst fractures account for 17% of all spinal fractures and due to their nature, are often associated with compromise of the spinal canal to some degree. With the rapid technological advances in imaging modalities, the options for imaging burst fractures have evolved. In order to ensure best practice, consideration should be given to choosing the most appropriate technologies instead of being tempted to use all of the modalities. This paper will explore the current multimodality approaches to imaging burst fractures in order to demonstrate the essential role of the MIT in optimizing the patient pathway.

2. BURST FRACTURES A Multimodality imaging approach Sophie Peryman Bachelor of Health Science (Medical Imaging) Unitec A Multimodality imaging approach Sophie Peryman Bachelor of Health Science (Medical Imaging) Unitec

3. OVERVIEW Definition Mechanisms of injury Classification systems Imaging pathways Summary

4. ASIANIA AIRLINES CRASH http://i2.cdn.turner.com/cnn/dam/assets/130706190825-san-francisco-plane-crash-18b-horizontal-gallery.jpg

5. ASIANIA AIRLINES CRASH http://www.nydailynews.com/news/national/asiana-flight-214-pilots-realized-seconds-crash-approach-slow-article-1.1392535

6. ASIANIA AIRLINES CRASH http://cdn-wac.emirates247.com/polopoly_fs/1.513667.1373338995!/image/3595643928.jpg

7. BURST FRACTURE DEFINED Failure of anterior and middle margins Potential for neurological damage Typical mechanisms of injury

8. MECHANISMS OF INJURY

9. INTERVERTEBRAL DISKS

11. 3-COLUMN CLASSIFICATION SYSTEM Denis (1983) Anterior column Middle column Posterior column Middle column considered to be of paramount importance to spinal stability

12. THORACOLUMBAR INJURY CLASSIFICATION & SEVERITY SCORE (TLICS) Vaccaro (2005) Based on three important injury characteristics: 1.Morphology of injury 2.Integrity of posterior ligamentous complex 3.Neurological status of the patient

13. CHOICE OF IMAGING MODALITY Cassar-Pullicino & Tins (2006) claim the biggest problem of imaging spinal injury patients is the choice of the appropriate imaging modality in the different stages of patient care.

14. CHOICE OF IMAGING MODALITY: XRAY 1.Severe compression of vertebral body 1.Disruption of posterior body line 1.Widening of interpedicle distance http://radiopaedia.org/articles/burst-fracture Abitol et al. (1992)

15. CHOICE OF IMAGING MODALITY: XRAY http://radiopaedia.org/articles/burst-fracture

16. CHOICE OF IMAGING MODALITY: CT http://radiopaedia.org/articles/burst-fracture

17. CHOICE OF IMAGING MODALITY: CT http://www.sciencephoto.com/image/426178/350wm/F0039177-Degenerative_disc_disease,_3D_CT_scan-SPL.jpg

18. CHOICE OF IMAGING MODALITY: MRI http://images.radiopaedia.org/images/11026/5c06fbb2b629222ff83a9518915302.jpg

19. SUMMARY

20. REFERENCES Abitbol, J., Ballock, R., Cervilla, V., Garfin, S., Mackersie, R., & Resnick, D. (1992). Can burst fractures be predicted from plain radiographs? The Bone & Joint Journal, 74, (1), 147 – 150. Retrieved from http://www.bjj.boneandjoint.org.uk/content/74- B/1/147.full.pdf+html Anderson, M., Kulstad, C., & Tuite, A. (2008). Thoracolumbar spine and pelvis plain radiography. In J. C. Fox (Ed.), Clinical Emergency Radiology (pp. 106 – 116). New York City: Cambridge University Press. Cowan, J & Rommey, L.. (2013). SF plane crash: injured suffer spinal injuries, internal bleeding. Retrieved from http://www.latimes.com/local/lanow/la-me-ln-san-francisco-plane-crash-injured-suffer-spinal-injuries-internal-bleeding- 20130706,0,2189046.story Daffner, R., Deeb., & Rothfus, W. (1987). The posterior vertebral body line: importance in the detection of burst fractures. Americal Journal of Roentgenology, 148 (1), 93 – 96. Retrieved from http://www.ajronline.org/doi/abs/10.2214/ajr.148.1.93 Daffner, R. H., & Daffner, S. D. (2006). Vertebral Injuries: Detection and Implications. In V. N. Cassar-Pullicino & H. Imhof, Spinal Trauma – An Imaging Approach (pp. 36 – 54). New York City: Theime. Fox, J. C., & Habicht, M. E. R. (2008). CT of the spine. In J. C. Fox (Ed.), Clinical Emergency Radiology (pp. 404 – 419). New York City: Cambridge University Press. Fox, J. C., & Harries, A. (2008). MRI of the spine. In J. C. Fox (Ed.), Clinical Emergency Radiology (pp. 538 – 559). New York City: Cambridge University Press. Government of Western Australia. (2013). Diagnostic Imaging Pathways – Thoraco-Lumbar Spine Injury. Retrieved from http://www.imagingpathways.health.wa.gov.au/index.php/imaging-pathways/musculoskeletal-trauma/bone-and-joint- trauma/thoraco-lumbar-spine-trauma#pathway Mayfield Clinic. (2013). Anatomy of the Spine. Retrieved from http://www.mayfieldclinic.com/PE-AnatSpine.htm#.UhR47xZH2_t OrthopedicsOne. (2012). Thorcolumbar burst fracture. Retrieved from http://www.orthopaedicsone.com/display/Main/Thoracolumbar+burst+fracture The USC Centre for Spinal Surgery. (2013). Thoracolumbar Spine Fractures. Retrieved from http://www.uscspine.com/conditions/spine-fractures.cfm Tins, B., & Cassar-Pullicino, V. N. (2006). Optimizing Imaging Options. In V. N. Cassar-Pullicino & H. Imhof, Spinal Trauma – An Imaging Approach (pp. 36 – 54). New York City: Theime. Rajasekaran, S. (2009). Thoracolumbar burst fractures without neurological deficit: the role for conservative treatment. Eur Spine J, 19 (1), 40 – 47. doi: 10.1007/s00586-009-1122-6 Zbeblick, T. (2012). Burst Fractures: defined and diagnosed. Retrieved from http://www.spineuniverse.com/conditions/spinal-fractures/burst- fractures-defined-diagnosed

21. Thank you for your attention!