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Typ-B-Distraktionsverletzungen der thorakolumbalen Wirbelsäule

Fehleinschätzungen des posterioren Ligamentkomplexes bei der radiologischen Diagnostik

Type B injuries of the thoracolumbar spine

Misinterpretations of the integrity of the posterior ligament complex using radiologic diagnostics

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Zusammenfassung

Hintergrund

Thorakolumbale Distraktionsverletzungen vom Typ B (AO-Klassifikation) stellen eine Operationsindikation dar. B1-Verletzungen weisen eine Verletzung des posterioren Ligamentkomplexes (PLC) auf, welche im Röntgen- und CT-Bild übersehen werden kann. Ziel dieser Studie war es, die Häufigkeit von Fehlklassifikationen zu bestimmen und die Gemeinsamkeiten von B1-Verletzungen herauszuarbeiten.

Methoden

Retrospektive Studie mit Auswertung von 361 Frakturen.

Ergebnisse

Von 93 evaluierten B-Verletzungen waren 39 (41,9%) primär nicht als solche erkannt und als A-Verletzung fehlklassifiziert worden. Dem Typ B1 entsprachen 59% der Verletzungen, von denen bei 29% keinerlei radiologische Zeichen auf eine PLC-Verletzung vorlagen. Bei den übrigen lagen am häufigsten folgende radiologische Zeichen vor: Segmentwinkel >15° (44%), ausgeprägte Kompression der Wirbelkörperspongiosa bei nur gering (<50%) reduzierter vorderer Wirbelkörperhöhe (41%) oder erhebliche Reduktion der vorderen Wirbelkörperhöhe auf <50% (31%).

Schlussfolgerung

Typ-B-Verletzungen werden regelmäßig primär nicht erkannt. Zur korrekten Diagnose müssen alle verfügbaren radiologischen und klinischen Zeichen berücksichtigt werden. Von allen B1-Verletzungen können 29% im Röntgen und CT nicht erkannt werden.

Abstract

Background

Type B injuries of the thoracolumbar spine (AO classification) indicate the need for surgical treatment. Type B1 injuries include disruption of the posterior ligament complex (PLC), which can be underdiagnosed when using x-ray and CT. The aims of this study were to determine the frequency of misclassification to compile similarities of type B1 injuries. Materials and Methods: Retrospective study evaluating 361 fractures.

Results

Initially, 39 (41.9%) of 93 type B injuries were misdiagnosed as type A. 59% of 93 injuries belonged in the type B1 category. 29% of these showed no radiological signs of a PLC injury. Among the remaining cases, the following signs were the most frequently seen: vertebral segmental angle >15° (44%), pronounced compression of vertebral cancellous bone despite minimal (<50%) reduced anterior vertebral height (41%), and a considerably reduced anterior vertebral height to <50% (31%).

Conclusion

Type B injuries are frequently misinterpreted. To achieve a correct diagnosis, all clinical and radiological signs must be considered. 29% of all type B1 injuries cannot be detected on x-ray or CT scan.

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Authors and Affiliations

  1. Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland

    K.J. Schnake & F. Kandziora

  2. Centrum für Muskuloskeletale Chirurgie, Charité, Universitätsmedizin Berlin, Berlin, Deutschland

    F. von Scotti & N.P. Haas

Authors
  1. K.J. Schnake
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  2. F. von Scotti
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  3. N.P. Haas
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  4. F. Kandziora
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Correspondence to K.J. Schnake.

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Schnake, K., von Scotti, F., Haas, N. et al. Typ-B-Distraktionsverletzungen der thorakolumbalen Wirbelsäule. Unfallchirurg 111, 977–984 (2008). https://doi.org/10.1007/s00113-008-1503-z

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  • DOI: https://doi.org/10.1007/s00113-008-1503-z

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