Advertisement

Skeletal Radiology

, Volume 39, Issue 8, pp 767–772 | Cite as

Spreading epidural hematoma and deep subcutaneous edema: indirect MRI signs of posterior ligamentous complex injury in thoracolumbar burst fractures

  • Na Ra Kim
  • Sung Hwan HongEmail author
  • Ja-Young Choi
  • Bong-Soon Chang
  • Joon Woo Lee
  • Jae Sung Myung
  • Sung Gyu Moon
  • Heung Sik Kang
Scientific Article

Abstract

Objectives

The purpose of this study was to evaluate the diagnostic value of a spreading epidural hematoma (SEH) and deep subcutaneous edema (DSE) as indirect signs of posterior ligamentous complex (PLC) injuries on MR imaging of thoracolumbar burst fractures.

Materials and Methods

We retrospectively reviewed spinal MR images of 43 patients with thoracolumbar burst fractures: 17 patients with PLC injuries (study group) and 26 without PLC injuries (control group). An SEH was defined as a hemorrhagic infiltration into the anterior or posterior epidural space that spread along more than three vertebrae including the level of the fracture. A DSE was regarded as a fluid-like signal lesion in the deep subcutaneous layer of the back, and its epicenter was at the burst fracture level. The frequency of the SEH/DSE in the two groups was analyzed. In addition, the association between each sign and the degree of vertebral collapse, the severity of central canal compromise, and surgical decisions were analyzed.

Results

Magnetic resonance images showed an SEH in 20 out of 43 patients (46%) and a DSE in 17 (40%). The SEH and DSE were more commonly seen in the study group with PLC injuries (SEH, 15 out of 17 patients, 80%; DSE, 16 out of 17 patients, 94%) than in the control group without PLC injuries (SEH, 5 out of 26, 19%; DSE, 1 out of 26, 4%) (P <0.0001). The SEH and DSE were significantly associated with surgical management decisions (17 out of 20 patients with SEH, 85%, vs 8 out of the 23 without SEH, 35%, P =0.002; 15 out of 17 with DSE, 88%, vs 10 out of 26 without DSE, 38%, P =0.002). The SEH and DSE did not correlate with the degree of vertebral collapse or the severity of central canal compromise.

Conclusion

The SEH and DSE may be useful secondary MR signs of posterior ligamentous complex injury in thoracolumbar burst fractures.

Keywords

Thoracic spine Lumbar spine Spinal injury Posterior ligamentous complex MRI 

References

  1. 1.
    Holdsworth FW. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Br. 1963;45:6–20.Google Scholar
  2. 2.
    Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8:817–31.CrossRefPubMedGoogle Scholar
  3. 3.
    James KS, Wenger KH, Schlegel JD, et al. Biomechanical evaluation of the stability of thoracolumbar burst fractures. Spine. 1994;19:1731–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Holdsworth FW. Fractures, dislocations and fracture dislocations of the spine (review). J Bone Joint Surg Am. 1970;52:1534–51.PubMedGoogle Scholar
  5. 5.
    Ferguson RL, Allen BL Jr. A mechanistic classification of thoracolumbar spine fractures. Clin Orthop. 1984;189:77–88.PubMedGoogle Scholar
  6. 6.
    Jelsma RK, Kirsch PT, Rice JF, et al. The radiographic description of thoracolumbar fractures. Surg Neurol. 1982;18:230–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Vaccaro AR, Lehman RA, Hurlbert RJ, et al. A new classification of thoracolumbar injuries. The importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine. 2005;30:2325–33.CrossRefPubMedGoogle Scholar
  8. 8.
    Vaccaro AR, Baron EM, Sanfilippo J, et al. Reliability of a novel classification system for thoracolumbar injuries: the thoracolumbar injury severity score. Spine. 2006;31:S62–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Haba H, Taneichi H, Kotani Y, et al. Diagnostic accuracy of magnetic resonance imaging for detecting posterior ligamentous complex injury associated with thoracic and lumbar fractures. J Neurosurg. 2003;99:20–6.PubMedGoogle Scholar
  10. 10.
    Lee HM, Kim HS, Kim DJ, et al. Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures. Spine. 2000;25:2079–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Goradia D, Linnau KF, Cohen WA, et al. Correlation of MR imaging findings with intraoperative findings after cervical spine trauma. Am J Neuroradiol. 2007;28:209–15.PubMedGoogle Scholar
  12. 12.
    Groves CJ, Cassar-Pullicino VN, Tins BJ, et al. Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology. 2005;236:601–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Bernstein MP, Mirvis SE, Shanmuganathan K. Chance-type fractures of the thoracolumbar spine: imaging analysis in 53 patients. Am J Roentgenol. 2006;187:859–68.CrossRefGoogle Scholar
  14. 14.
    Terk MR, Hume-Neal M, Fraipont M, et al. Injury of the posterior ligament complex in patients with acute spinal trauma: evaluation by MR imaging. Am J Roentgenol. 1997;168:1481–6.Google Scholar

Copyright information

© ISS 2010

Authors and Affiliations

  • Na Ra Kim
    • 1
    • 2
  • Sung Hwan Hong
    • 1
    • 5
    Email author
  • Ja-Young Choi
    • 1
  • Bong-Soon Chang
    • 4
  • Joon Woo Lee
    • 3
  • Jae Sung Myung
    • 1
  • Sung Gyu Moon
    • 2
  • Heung Sik Kang
    • 3
  1. 1.Department of RadiologySeoul National University College of MedicineSeoulKorea
  2. 2.Department of RadiologyKonkuk University School of MedicineSeoulKorea
  3. 3.Department of RadiologySeoul National University Bundang HospitalSeoulKorea
  4. 4.Department of Orthopedic SurgerySeoul National University College of MedicineSeoulKorea
  5. 5.Department of RadiologySeoul National University HospitalSeoulKorea

Personalised recommendations