Imaging Case of the Week 96

The following AP and lateral thoracolumbar junction x-rays are from a 38 year old man who has been involved in a MVA. What do you notice on the x-rays?

Thoracolumbar AP

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Thoracolumbar lateral

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The thoracolumbar junction x-ray views show a compression fracture of L1 involving the superior vertebral end plate and the anterior body; there is also an undisplaced fracture of the spinous process of T12.

CT scans showed a compression fracture of L1 with no retropulsion of fragments. There was also a T12 spinous process fracture with an extension to the right facet joint.

This is a variant of a Chance fracture and is an unstable injury.

The patient did not have any abdominal/retroperitoneal injuries on CT and there was no neurological deficit. He was managed conservatively with a spinal brace.

Thoracolumbar CT lateral

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3D CT images from the same patient:


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3D CT lateral

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Chance fracture:

  • Is a flexion-distraction injury related to lap seat belt use. It can also occur following a fall from a height.
  • It is a horizontal fracture involving the anterior and posterior vertebral elements (vertebral body, pedicles and the spinous process)
  • Tends to occur between T12 and L4.
  • High incidence of gastrointestinal injuries (in up to 50% patients) involving the liver, spleen, duodenum or pancreas. Ecchymosis of the anterior abdominal wall should raise suspicion for the presence of this fracture.
  • Be suspicious of compression fractures in young patients involved in an MVA.